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NRS-465 Benchmark Literature Review
If you’re enrolled in NRS-465 at Grand Canyon University and staring at the NRS-465 Benchmark Literature Review, here’s the short overview: you need to write a 750–1,000 word synthesis paper, not article summaries, using 8 peer-reviewed sources that support your PICOT question. This guide breaks down every required section, explains exactly how to write a passing synthesis, and includes a fully worked free example so you can see what a strong submission looks like before you write a single word.
Benchmark – Capstone Change Project: Literature Review
While the implementation plan prepares learners to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables learners to map out and move into the active planning and development stages of the project.
A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Learners will use the PICOT question from the earlier “Capstone Change Project: PICOT Question Development” template and information from the “Capstone Change Project: Literature Evaluation Table,” associated with the Topic 4 assignment, to develop a review.
Using eight peer-reviewed articles, write 750-1,000-word review which, when looking at all of the studies together, includes the following sections:
- Introduction (including PICOT question)
- A summary of the purpose of the studies
- A comparison of sample populations
- A synthesis of the studies’ conclusions (When looking at all of the studies together, group the conclusions by themes.)
- A summary of the limitations of the studies
- A conclusion, incorporating recommendations for further research
You are required to cite a minimum of eight peer-reviewed articles to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
What Is the NRS-465 Benchmark Literature Review?
The NRS-465 Benchmark Literature Review is a graded, LopesWrite-submitted writing assignment due in Topic 6 of Grand Canyon University’s Applied Evidence-Based Project and Practicum course. It builds directly on the Literature Evaluation Table you completed in Topic 4 — using the same 8 peer-reviewed articles — but requires you to move from individual article analysis into true academic synthesis.
This is one of the most commonly misunderstood assignments in the NRS-465 sequence. Many students write it as a series of article-by-article summaries, which is a Topic 4 approach, not a Topic 6 approach. Topic 6 requires you to group conclusions across all studies by theme and present a unified argument about what the body of evidence collectively shows.
Word count: 750–1,000 words
Source requirement: Minimum 8 peer-reviewed articles, published within the past 5 years
Format: APA 7th edition
Submission: LopesWrite required
How Is the NRS-465 Literature Review Different from the Literature Evaluation Table?
The Literature Evaluation Table (Topic 4) and the Literature Review (Topic 6) use the same 8 articles but serve completely different purposes.
| Assignment | Format | Approach |
|---|---|---|
| Topic 4 — Lit Evaluation Table | Grid/table | Article-by-article analysis |
| Topic 6 — Literature Review | Narrative paper | Cross-study synthesis by theme |
Think of Topic 4 as laying out the building materials and Topic 6 as constructing the actual building. The articles don’t change — how you connect and present them does.
A common grading error: students write Topic 6 like this: “Smith et al. (2022) found that… Jones et al. (2023) found that…” That is a summary, not a synthesis. A synthesis reads: “Three studies consistently demonstrated that structured patient education reduced 30-day readmission rates (Smith et al., 2022; Jones et al., 2023; Lee et al., 2021).”
What Sections Does the NRS-465 Literature Review Require?
The GCU rubric specifies six required sections. Each is graded separately.
1. Introduction (Including PICOT Question)
Open with context for the clinical problem and state your finalized PICOT question in full. This section should be 100–150 words. Be specific — vague introductions are the most common reason students score at the “Approaching” level on the rubric.
2. Summary of the Purpose of the Studies
Describe why the studies were conducted — what problem or gap in the literature each set out to address. Group by shared aim where possible. This is not a list of article titles; it is a thematic overview of research intent.
3. Comparison of Sample Populations
Compare the populations studied across all 8 articles: Who were the participants? What were the settings (ICU, outpatient, community)? What were the sample sizes? Note any meaningful differences — for example, studies conducted in rural versus urban settings, or pediatric versus adult populations.
4. Synthesis of the Studies’ Conclusions (Grouped by Theme)
This is the most heavily weighted section and the one most students struggle with. Group the conclusions of all 8 studies into 2–3 recurring themes. Do not discuss articles individually. Write each thematic paragraph by drawing from multiple studies simultaneously.
Strong synthesis example:
“A consistent theme across five studies was that nurse-led education interventions significantly reduced preventable patient complications. Ahmed et al. (2022), Park & Kim (2023), and Torres et al. (2021) all reported statistically significant reductions in adverse outcomes when standardized education protocols were implemented compared to standard care.”
5. Summary of the Limitations of the Studies
Identify the main limitations across the body of evidence as a whole. Common limitations include small sample sizes, single-site study designs, short follow-up periods, and self-reported data. Group similar limitations together rather than listing each article’s limitations individually.
6. Conclusion and Recommendations for Further Research
Summarize what the collective evidence establishes and identify specific gaps that future research should address. Be concrete — “more research is needed” is not a recommendation. State what type of study, in what population, addressing what gap, would meaningfully advance the evidence base.
How to Write the Synthesis Section (The Part Most Students Get Wrong)
The synthesis section requires you to write about themes, not articles. This is the single most important technique distinction in the entire assignment.
Follow this three-step process:
- Identify themes first. Read through your 8 articles’ conclusions and highlight recurring findings. Aim for 2–3 themes, each supported by at least 2–3 of your articles.
- Draft topic sentences that name the theme, not the study. Start each paragraph with a declarative claim: “Bundle-based care interventions consistently reduced hospital-acquired infection rates across ICU settings.” Then bring in the supporting studies.
- Cite multiple articles per sentence where possible. Every synthesis paragraph should have sentences that cite 2+ articles simultaneously. This signals to your instructor — and to the GCU rubric — that you are synthesizing, not summarizing.
Common pitfall to avoid: Do not organize your synthesis section by article number or author name. Organize it by finding. If your subheadings (or mental structure) are “Article 1,” “Article 2,” you are writing a summary, not a synthesis.
Word Count Budget for Each Section
The total assignment is 750–1,000 words. Use this as a guide:
| Section | Suggested Word Count |
|---|---|
| Introduction + PICOT | 100–150 words |
| Purpose of studies | 100–150 words |
| Sample populations | 100–150 words |
| Synthesis of conclusions | 250–350 words |
| Limitations | 80–120 words |
| Conclusion + further research | 100–150 words |
Do not pad sections to hit the word count. GCU rubrics reward depth and specificity, not length.
How to Choose a Strong PICOT Topic for NRS-465
The best NRS-465 PICOT topics have a clear nursing intervention, a measurable outcome, and abundant peer-reviewed literature published in the last five years.
High-yield topics that consistently yield 8+ strong peer-reviewed articles:
- Fall prevention in hospitalized adult patients
- Sepsis bundle compliance in ICU settings
- Nurse burnout and its impact on patient safety outcomes
- Diabetes self-management education in outpatient settings
- Hospital-acquired pressure injury (HAPI) prevention
- Hand hygiene compliance and healthcare-associated infection reduction
- Central line-associated bloodstream infection (CLABSI) prevention
Avoid topics that are too broad (e.g., “improving patient outcomes”) or overly narrow — if you cannot find 8 peer-reviewed studies published after 2020, the topic is too niche for this assignment.
The Completed Literature Evaluation Table (Topic 4): What the Example Is Based On
Before reading the literature review example below, understand that it flows directly from a fully completed NRS-465 Literature Evaluation Table — the Topic 4 assignment that precedes this paper. The table below shows the eight articles used, their study designs, and their key findings in the exact format GCU’s template requires.
PICOT Question used in both assignments: In adult patients aged 65 and older in acute care hospital settings (P), how does the implementation of a standardized multifactorial fall prevention program (I) compared to standard fall precaution protocols alone (C) affect the incidence of inpatient falls and fall-related injuries (O) over a six-month period (T)?
Literature Search Strategy: CINAHL, PubMed, and Cochrane Library. Keywords: fall prevention, inpatient falls, fall prevention bundle, multifactorial fall intervention, Morse Fall Scale, nursing fall protocol, patient education falls, older adults hospital falls. Filters: peer-reviewed, 2020–2025, English, human subjects.
The 8 Articles at a Glance
| # | Author(s) & Year | Design | Setting | Sample | Key Finding |
|---|---|---|---|---|---|
| 1 | Barker et al. (2022) | Cluster RCT | Acute hospital wards, Melbourne, Australia | N=26,664 admissions | 6-PACK bundle reduced injurious falls by 30% (p=0.006) |
| 2 | Huang et al. (2021) | Systematic review + meta-analysis | 11 RCTs, USA/China/Taiwan/Australia | N=6,842 pooled | Patient teach-back education reduced falls by 37% |
| 3 | Kim & Park (2023) | Quasi-experimental pre-post | Medical-surgical units, Seoul, South Korea | N=3,847 admissions | Nurse-driven protocol reduced fall rates by 42% (p<0.001) |
| 4 | Torres et al. (2021) | Pre-post intervention | Neurology/orthopaedic units, Texas, USA | N=84 RNs; 2,160 encounters | Simulation education improved protocol adherence by 28 percentage points |
| 5 | Nguyen & Walsh (2022) | Quality improvement pre-post | Acute medical units, Ohio, USA | N=1,540 handoffs; 1,204 patients | SBAR handoff tool reduced post-handoff falls by 19% |
| 6 | Patel et al. (2022) | Systematic review | 14 studies, North America/Europe/Asia | N=47,382+ pooled | Bundles with 4+ components reduced falls by 25–45% |
| 7 | Chen et al. (2023) | Prospective cohort | Inpatient units, Guangzhou, China | N=4,218 patients aged 65+ | Morse Fall Scale outperformed STRATIFY (AUC 0.79 vs 0.71) |
| 8 | Okonkwo et al. (2021) | Pilot RCT | Medical units, Nashville, Tennessee, USA | N=87 patients aged 65+ | Family engagement coaching reduced falls by 37% |
Download the fully completed Literature Evaluation Table – every field filled in for all 8 articles in GCU’s exact template format.
NRS-465 Literature Review: Free Worked Example
The following is a complete literature review example based on the fully completed Literature Evaluation Table (Topic 4 template) provided above. All eight articles cited below are drawn directly from that table — the same PICOT question, same sources, same findings. This is what a correctly executed Topic 6 synthesis looks like when it flows from a properly completed Topic 4 table. Download the completed table above to see every article’s full data side-by-side.
Benchmark – Capstone Change Project: Literature Review
Learner’s Name: [Your Name]
Faculty’s Name: [Your Professor’s Name]
Course: NRS-465 — Applied Evidence-Based Project and Practicum
Date: [Submission Date]
Introduction
Inpatient falls are among the most prevalent and preventable patient safety events in acute care hospitals, affecting an estimated 700,000 to 1,000,000 patients annually in the United States (Agency for Healthcare Research and Quality [AHRQ], 2019). Older adults aged 65 and above bear a disproportionate share of this burden due to compounding risk factors including polypharmacy, reduced muscle strength, and cognitive vulnerability. Despite widespread adoption of standard fall precaution protocols, inpatient fall rates in many facilities remain above acceptable benchmarks, signaling an urgent need for more structured, evidence-based approaches.
This literature review synthesizes evidence from eight peer-reviewed studies published between 2021 and 2023 to evaluate whether multifactorial fall prevention programs outperform standard protocols in reducing inpatient falls and fall-related injuries. The review is organized around the following PICOT question: In adult patients aged 65 and older in acute care hospital settings (P), how does the implementation of a standardized multifactorial fall prevention program (I) compared to standard fall precaution protocols alone (C) affect the incidence of inpatient falls and fall-related injuries (O) over a six-month period (T)?
Purpose of the Studies
The eight studies share a unified aim — to generate evidence supporting more effective, systematic approaches to fall prevention in hospitalized adults. Barker et al. (2022) and Kim and Park (2023) evaluated the direct impact of nurse-driven multicomponent bundles on unit-level fall and injury rates. Patel et al. (2022) and Huang et al. (2021) examined the literature more broadly, with Patel et al. synthesizing 14 studies on bundle effectiveness and Huang et al. conducting a meta-analysis of 11 patient education trials.
Torres et al. (2021) investigated how simulation-based nursing education affects protocol adherence, while Nguyen and Walsh (2022) examined the specific role of structured handoff communication in preventing post-handoff falls. Chen et al. (2023) addressed the risk identification step by comparing the predictive accuracy of the Morse Fall Scale and STRATIFY tool, and Okonkwo et al. (2021) piloted a patient and family engagement intervention. Together, the studies address every component of a multifactorial program — risk stratification, bundle implementation, nursing education, communication, and patient activation — establishing a comprehensive evidence base for the PICOT question.
Comparison of Sample Populations
The eight studies collectively represent a broad and largely inpatient-focused evidence base, though with meaningful variation in sample size, geography, and patient characteristics. Six studies were conducted in acute care inpatient settings — specifically medical-surgical, neurology, orthopaedic, and general medical units — across the United States, South Korea, China, and Australia (Barker et al., 2022; Kim & Park, 2023; Torres et al., 2021; Nguyen & Walsh, 2022; Chen et al., 2023; Okonkwo et al., 2021). The remaining two studies were systematic reviews or meta-analyses that pooled data from multiple countries and settings (Huang et al., 2021; Patel et al., 2022).
Sample sizes varied substantially, ranging from 87 patients in Okonkwo et al.’s (2021) pilot RCT to 4,218 patient encounters in Chen et al.’s (2023) prospective cohort study, and a pooled total exceeding 47,000 patients in Patel et al.’s (2022) systematic review. All studies focused on adult patients aged 60 or older, with the majority explicitly targeting patients 65 and above. A notable population gap exists across the literature: five of the eight studies excluded patients with significant cognitive impairment, restricting generalizability to one of the highest-risk subgroups in acute care fall prevention.
Synthesis of the Studies’ Conclusions
Theme 1: Multicomponent bundles produce substantially greater fall reductions than standard protocols alone. The most consistent and robust finding across the literature is that fall prevention programs combining four or more concurrent components — risk assessment, patient education, environmental modification, and nursing communication — significantly outperform single-element or standard precaution-only approaches. Barker et al. (2022) reported a 30% reduction in injurious falls in wards implementing the 6-PACK bundle compared to usual care (IRR 0.70, p=0.006).
Kim and Park (2023) found a 42% decrease in fall rates following protocol implementation (3.8 vs. 2.2 falls/1,000 bed-days; p<0.001). Patel et al.’s (2022) systematic review of 14 studies corroborated these findings, reporting bundle-associated fall reductions of 25–45% across 12 of 14 included studies and identifying environmental modification and patient education as the two most consistently effective individual components.
Theme 2: Nursing education and structured communication are essential to sustaining program effectiveness. Improvements achieved through bundle implementation are undermined when nursing staff lack consistent knowledge of protocols or fail to communicate fall risk across shift transitions. Torres et al. (2021) demonstrated that simulation-based education produced a 28-percentage-point improvement in protocol adherence, more than three times the gain seen with standard online training, along with a 31% unit-level fall rate reduction over six months.
Nguyen and Walsh (2022) found that an SBAR-based handoff tool with a mandatory fall risk field reduced post-handoff falls by 19% and achieved 91% staff compliance by week eight of implementation. These findings establish that the human and communication infrastructure surrounding a fall prevention bundle is as important as the bundle’s clinical components.
Theme 3: Accurate risk stratification and patient engagement amplify program outcomes. The effectiveness of any fall prevention intervention depends first on correctly identifying which patients are at risk and then activating patients themselves as partners in safety. Chen et al. (2023) established that the Morse Fall Scale offers superior sensitivity (81% vs. 73%) and predictive accuracy compared to the STRATIFY tool in adults aged 65 and older, providing clear guidance for the risk stratification step of a multifactorial program.
Okonkwo et al. (2021) and Huang et al. (2021) demonstrated the downstream impact of patient engagement: structured coaching and teach-back education reduced falls by 37% and 37%, respectively, compared to standard precaution education. Patel et al. (2022) independently confirmed that patient education was among the two most impactful bundle components across 14 studies, reinforcing the clinical value of shifting patients from passive recipients of fall precautions to active partners in their own safety.
Limitations of the Studies
Several methodological limitations temper the certainty of these findings. Five of the eight studies used pre-post or quasi-experimental designs without randomisation (Kim & Park, 2023; Torres et al., 2021; Nguyen & Walsh, 2022; Barker et al., 2022; Chen et al., 2023), limiting the ability to establish causality and control for confounding. Okonkwo et al.’s (2021) pilot RCT was adequately randomised but severely underpowered with a sample of 87 patients, making it insufficient to detect small to moderate effect sizes.
The two systematic reviews (Huang et al., 2021; Patel et al., 2022) were constrained by significant heterogeneity in bundle components, outcome definitions, and follow-up periods across included studies, preventing formal meta-analysis in Patel et al.’s case. Most critically, five studies excluded patients with cognitive impairment — a population representing a disproportionate share of inpatient falls — substantially limiting generalisability to real-world acute care settings where dementia and delirium are prevalent.
Conclusion and Recommendations for Further Research
The cumulative evidence from these eight studies strongly supports replacing standard fall precaution protocols with standardized multifactorial fall prevention programs in acute care settings serving adults aged 65 and older. The literature is consistent in demonstrating that bundles combining the Morse Fall Scale for risk stratification, nursing education delivered through simulation, structured handoff communication, environmental modification, and patient teach-back education achieve fall rate reductions of 25–42% compared to usual care.
To advance the field, future research should prioritise large-scale, multi-site randomised controlled trials with extended follow-up periods beyond six months to assess long-term sustainability. Research specifically designed for patients with mild to moderate cognitive impairment is critically needed, as this population is currently underrepresented in the literature despite carrying elevated fall risk. Implementation science studies examining which bundle components are most difficult to sustain, and what organisational conditions enable adherence, would provide actionable guidance for nurse leaders and hospital administrators seeking to move from pilot programs to institution-wide standards of care.
References
Barker, A. L., Morello, R. T., Wolfe, R., et al. (2022). 6-PACK programme to decrease fall injuries in acute hospitals: Cluster randomised controlled trial. BMJ, 376, e067557. https://doi.org/10.1136/bmj-2021-067557
Chen, Y., Liu, W., Wang, H., & Zhang, Q. (2023). Fall risk assessment tools in hospitalised older adults: Comparative accuracy of Morse Fall Scale and STRATIFY in predicting inpatient falls. Geriatric Nursing, 49, 112–120. https://doi.org/10.1016/j.gerinurse.2022.11.014
Huang, L., Conner, B. T., & Liu, X. (2021). The effect of patient education on fall prevention in hospitalised older adults: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3395–3408. https://doi.org/10.1111/jan.14849
Kim, S., & Park, J. H. (2023). Effectiveness of a nurse-driven fall prevention protocol in a tertiary hospital: A quasi-experimental study. International Journal of Nursing Studies, 140, 104453. https://doi.org/10.1016/j.ijnurstu.2023.104453
Nguyen, T. T., & Walsh, K. A. (2022). Structured handoff communication and fall prevention in acute care: A quality improvement project. Journal of Nursing Care Quality, 37(1), 45–52. https://doi.org/10.1097/NCQ.0000000000000574
Okonkwo, E. N., Bell, S. P., & Griffith, M. V. (2021). Patient and family engagement in fall prevention during hospitalisation: A pilot randomised controlled trial. Patient Education and Counseling, 104(7), 1698–1705. https://doi.org/10.1016/j.pec.2020.12.019
Patel, R., Singh, A., & Okafor, N. (2022). Multicomponent fall prevention bundles in adult inpatient settings: A systematic review. Worldviews on Evidence-Based Nursing, 19(4), 280–291. https://doi.org/10.1111/wvn.12579
Torres, M. A., Hernandez, L., & Reyes, C. (2021). Impact of simulation-based nursing education on fall prevention protocol adherence: A pre-post intervention study. Nurse Education Today, 97, 104680. https://doi.org/10.1016/j.nedt.2020.104680
This example is provided as a reference model only. All article data above matches the completed Literature Evaluation Table (Topic 4 template) available for download on this page.
Why GCU Students Struggle with This Assignment
The NRS-465 Literature Review trips up students not because the writing is hard, but because the synthesis skill is unfamiliar. Most RN-to-BSN and MSN students have years of clinical expertise but limited experience writing academic synthesis papers. The assignment asks for a skill that isn’t practiced in clinical settings — the ability to step back from individual data points and identify collective patterns.
Three specific struggles come up repeatedly:
- Writing summaries instead of synthesis — the most common grading deduction
- Underdeveloped PICOT questions — vague PICOT questions make it harder to unify the literature under a coherent argument
- Weak conclusion sections — students write “more research is needed” without specifying what kind, in what population, addressing what gap
If any of these describe where you are right now, the sample above and the Gradevia team can help you get unstuck.
Frequently Asked Questions
Q: What is the difference between the NRS-465 Literature Evaluation Table and the Literature Review?
The Literature Evaluation Table (Topic 4) is a structured grid where you analyze each article individually. The Literature Review (Topic 6) uses those same articles but requires you to write a narrative synthesis — grouping findings across all studies by theme. Writing Topic 6 as article-by-article summaries is the most common grading mistake.
Q: Can I use the same articles from my Topic 4 Literature Evaluation Table?
Yes, and you are expected to. The assignment instructions explicitly state that students should draw from the PICOT question developed earlier and the Literature Evaluation Table completed in Topic 4. Your 8 articles remain the same; the Task is to synthesize them, not find new ones.
Q: How long should each section of the NRS-465 Literature Review be?
The full paper is 750–1,000 words. Budget roughly 100–150 words for the introduction, 100–150 for study purpose, 100–150 for sample populations, 250–350 for the synthesis section, 80–120 for limitations, and 100–150 for your conclusion. The synthesis section should be your longest — it carries the most rubric weight.
Q: What clinical topics are best for the NRS-465 capstone literature review?
Topics with strong peer-reviewed literature published after 2020 are best: fall prevention in hospitalized adults, sepsis bundle compliance, nurse burnout and patient safety, diabetes self-management education, pressure injury prevention, and CLABSI prevention are all high-yield choices with abundant recent evidence.
Q: How do I write a synthesis instead of a summary?
Organize your synthesis section by theme, not by article. Draft topic sentences that state a collective finding first, then bring in 2–3 supporting citations. A synthesis sentence reads: “Three studies found that bundle-based interventions reduced HAI rates (Author A, 2022; Author B, 2023; Author C, 2021)” — not “Author A found that… Author B found that…”
Author Bio
This article was written by the Gradevia academic content team, which includes MSN-prepared nurses and evidence-based practice specialists with direct experience supporting RN-to-BSN and MSN students in GCU’s nursing programs. Our writers hold advanced nursing degrees and have completed capstone projects aligned with GCU’s NRS-465 and NRS-493 course sequences. Content is reviewed for academic accuracy and APA compliance before publication.
Article Update Log
| Date | Update |
|---|---|
| June 9, 2026 | Original publication — complete guide and free 850-word fall prevention literature review example added. |