An integrative review provides a broader summary of the literature and includes findings from a range of research designs. It gathers and synthesizes both empirical and theoretical evidence relevant to a clearly defined problem. It may include case studies, observational studies, and meta-analyses, but may also include practice applications, theory, and guidelines. It is the only approach that allows for the combination of diverse methodologies. Its aim is to develop a holistic understanding of the topic, present the state of the science and contribute to theory development. The integrative review has been advocated as important for evidence-based practice initiatives in nursing (Hopia et al., 2016).
Integrative reviews are popular in nursing because they use diverse data sources to investigate the complexity of nursing practice. An integrative review addresses the current state of the evidence, the quality of the available evidence, identifies gaps in the literature and suggests future directions for research and practice The clinical question(s) of an integrative review is broader than that of a systematic review, yet should be clearly stated and well-defined. As with a systematic review, an integrative review requires a transparent and rigorous systematic approach (Remington & Toronto, 2020).
Integrative reviews synthesize research data from various research designs to reach comprehensive and reliable conclusions. An integrative review helps to develop a comprehensive understanding of the topic by synthesizing all forms of available evidence (Dhollande et al., 2021). They allow healthcare professionals to use all available evidence from both qualitative and quantitative research to provide a more holistic understanding of the topic, which can then be applied to clinical practice. Sampling for an integrative review may include experimental and nonexperimental (empirical) and theoretical literature (Remington & Toronto, 2020).
See Table 2: Steps of the integrative review (IR) process with key points and lessons learned
1: Select a Topic: Formulate a purpose and/or review question(s). An integrative review can be used to answer research questions related to nursing and other disciplines. Clearly identify a problem from a gap in the literature. Perform a quick search for other literature reviews related to the topic of interest to avoid duplication. Integrative review questions should be broad in scope, but narrow enough that the search is manageable. It should be well-defined, and clearly stated. Provide background on the topic and justification for the integrative review. Do a quick literature search to determine if any recent integrative or other types of reviews on or related to the topic have been performed.
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2. Write a Purpose Statement including clear aims of the analysis early in the process to guide later stages of the review. Identify a theoretical framework (if applicable) to guide the review. Choosing a theoretical framework can help place the results of the integrative review into the larger body of nursing knowledge |
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3: Conduct a Literature Search Define key search terms. Thoroughly document the search process and your decisions. Keep in mind that an integrative review uses multiple types of sources and studies. Use at least 2–3 sources, including electronic databases and/or sources of grey literature and handsearching the literature. Include experimental and non-experimental studies. The literature search should be comprehensive and use a replicable search strategy to collect data. Consult a librarian to ensure thoroughness and accuracy of the search. Follow steps for reporting the search in PRISMA guidelines. The steps should be well-documented and replicable. Organize sources used in the IR, a citation manager program, such as Zotero |
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4: Organize and Evaluate Data Create a data table to organize and display results. Evaluate the data to assess both quality and relevance to your topic. To assess the quality of selected studies, use critical appraisal tools (see box below) for evaluating the methodological quality of studies. Create a data table to organize and display results. Document all decisions. |
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5: Analyze and Synthesize Data Extract data and analyze. Use a table to cluster, compare, and contrast data sources. Assess how well each data source answers the research question. Identify patterns, themes and relationships among the data sources. Integrative reviews require a narrative analysis and integration of large amount of existing data to generate a new perspective on the topic. Continue to document and use transparent and reproducible methods. |
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6: Summarize Results and Formulate Conclusions Consider how to most effectively present and summarize conclusions, such as with a table or series of tables. Address how the review contributes to the larger body of literature related to the topic. Generate and suggest new research questions. |
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7: Disseminate Findings Ensure findings contribute to evidence-based practice and generation of new knowledge. Consider your target audience and how to most effectively share your findings via publication, presentation at conferences, and/or online media outlets. |
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References: |
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Critical Appraisal Skills Programme (CASP) Checklists Appraisal checklists designed for use with Systematic Reviews, Randomized Controlled Trials, Cohort Studies, Case Control Studies, Economic Evaluations, Diagnostic Studies, Qualitative studies and Clinical Prediction Rule.
Mixed Methods Appraisal Tool (MMAT) The MMAT is a critical appraisal tool that is designed for the appraisal stage of systematic mixed studies reviews, i.e., reviews that include qualitative, quantitative and mixed methods studies. It permits to appraise the methodological quality of five categories to studies: qualitative research, randomized controlled trials, non-randomized studies, quantitative descriptive studies, and mixed methods studies. (Hong et al., 2018).
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