The integrative review: updated methodology

1 METHODOLOGICAL ISSUES IN NURSING RESEARCHThe integrative review: updated methodologyRobin WhittemorePhD APRNA ssociate research Scientist and Lecturer, School of Nursing, Yale University, Connecticut, USAK athleen KnaflPhDElizabeth N. Gray Distinguished Professor and Associate Dean for research and Faculty Affairs, School of Nursing, OregonHealth and Sciences University, Oregon, USAA ccepted for publication 16 February 2005 Correspondence:Kathleen Knafl,School of Nursing,Oregon Health and Sciences University,Portland,Oregon 97239-3098, : R.

2 & KNAFL K. (2005)WHITTEMORE R. & KNAFL K. (2005)Journal of Advanced Nursing52(5), 546 553 The integrative review: updated aim of this paper is to distinguish the integrative review method fromother review methods and to propose methodological strategies specific to theintegrative review method to enhance the rigour of the evidence-based practice initiatives have increased the need forand the production of all types of reviews of the literature ( integrative reviews,systematic reviews, meta-analyses, and qualitative reviews).

3 The integrative reviewmethod is the only approach that allows for the combination of diverse method-ologies (for example, experimental and non-experimental research ), and has thepotential to play a greater role in evidence-based practice for nursing. With respectto the integrative review method, strategies to enhance data collection and extrac-tion have been developed; however, methods of analysis, synthesis, and conclusiondrawing remain poorly modified framework for research reviews is presented to addressissues specific to the integrative review method.

4 Issues related to specifying thereview purpose, searching the literature, evaluating data from primary sources,analysing data, and presenting the results are discussed. Data analysis methods ofqualitative research are proposed as strategies that enhance the rigour of combiningdiverse methodologies as well as empirical and theoretical sources in an updated integrative review method has the potential to allow fordiverse primary research methods to become a greater part of evidence-basedpractice :evidence-based practice, integrative review, methodology , nursingIntroductionAn integrative review is a specific review method thatsummarizes past empirical or theoretical literature to providea more comprehensive understanding of a particular phe-nomenon or healthcare problem (Broome 1993).

5 Integrativereviews, thus, have the potential to build nursing science,informing research , practice, and policy initiatives. Well-doneintegrative reviews present the state of the science, contributeto theory development, and have direct applicability topractice and evidence-based practice initiatives have increasedthe need for and the production of all types of literaturereviews ( integrative reviews, systematic reviews, meta-analy-ses, and qualitative reviews). The proliferation of all types ofresearch reviews during the past decade has contributed tomore systematic and rigorous methods.

6 Much has beenlearned about the methodology associated with combining546 2005 Blackwell Publishing Ltddisparate studies into integrated results and conclusions,particularly with respect to systematic review and meta-analyses approaches (Cooper 1998, Greenhalgh 1997). Yet,concern has been raised that these review methods, whileimportant for evidence-based practice, do not include thedepth and breadth of nursing research as they overemphasizethe randomized clinical trial and hierarchies of evidence(Kirkevold 1997, Evans & Pearson 2001).

7 To date, evidence-based practice initiatives have viewed different types ofevidence ( quantitative and qualitative) as mutuallyexclusive (Evans & Pearson 2001).The integrative review method is an approach that allowsfor the inclusion of diverse methodologies ( experimentaland non-experimental research ) and has the potential to playa greater role in evidence-based practice for nursing. Theintegrative review contributes to the presentation of variedperspectives on a phenomenon of concern and has beenadvocated as important to nursing science and nursingpractice (Kirkevold 1997, Estabrooks 1998, Evans & Pearson2001).

8 However, the complexity inherent in combiningdiverse methodologies can contribute to lack of rigour,inaccuracy, and bias (Beck 1999, O Mathuna 2000). Meth-ods to enhance data collection ( literature search) and dataextraction have been developed (Garrard 2004, Connet ); however, methods of analysis, synthesis, and conclu-sion-drawing remain poorly formulated. This is a consider-able issue, as the data extracted from primary articles ofdiverse methodologies generally consist of a large repertoireof varied data.

9 Explicit and systematic methods for dataanalysis specific to the integrative review method are neededto protect against bias and improve the accuracy of conclu-sions. In addition, little attention has been paid to issuesrelated to combining empirical and theoretical reports. Thepurpose of this paper, therefore, is to distinguish theintegrative review method from other review methods andto propose methodological strategies specific to the integra-tive review method to enhance its rigour. An updatedintegrative review method has the potential to allow fordiverse primary research methods to become a greater part ofevidence-based practice of conducting reviews of the health care literaturehave been used since the 1970s in an effort to synthesizefindings from discrete primary studies and to increase thegeneralizability of data about a phenomenon (Jackson 1980).

10 Methods to improve rigour continue to evolve because of thecomplexity of conducting a thorough review (Greenhalgh1997). While there are commonalities to all current reviewmethods (meta-analyses, systematic reviews, qualitativereviews, integrative reviews), each has a distinct purpose,sampling frame, definition, and type of analysis (Whittemore2005a).Meta-analysis is a research review method that combinesthe evidence of multiple primary studies by employingstatistical methods, thus enhancing the objectivity andvalidity of findings (Glass 1976).