dhollande2021_conducting integrative reviews a guide for novice nurses

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<p>Conducting integrative</p><p>reviews: a guide for novice</p><p>nursing researchers</p><p>Shannon Dhollande</p><p>Lecturer, School of Nursing, Midwifery & Social Sciences, CQ University Brisbane, Australia</p><p>Annabel Taylor</p><p>Professor, School of Nursing, Midwifery & Social Sciences, CQ University Brisbane, Australia</p><p>Silke Meyer</p><p>Associate Professor, School of Social Sciences, Monash University, Australia</p><p>Mark Scott</p><p>Emergency Consultant, Emergency Department, Caboolture Hospital, Australia</p><p>Abstract</p><p>Background: Integrative reviews within healthcare promote a holistic understanding of the</p><p>research topic. Structure and a comprehensive approach within reviews are important to</p><p>ensure the reliability in their findings.</p><p>Aim: This paper aims to provide a framework for novice nursing researchers undertaking</p><p>integrative reviews.</p><p>Discussion: Established methods to form a research question, search literature, extract data,</p><p>critically appraise extracted data and analyse review findings are discussed and exemplified using</p><p>the authors’ own review as a comprehensive and reliable approach for the novice nursing</p><p>researcher undertaking an integrative literature review.</p><p>Conclusion: Providing a comprehensive audit trail that details how an integrative literature</p><p>review has been conducted increases and ensures the results are reproducible. The use of</p><p>established tools to structure the various components of an integrative review increases</p><p>robustness and readers’ confidence in the review findings.</p><p>Implications for practice: Novice nursing researchers may increase the reliability of their</p><p>results by employing a framework to guide them through the process of conducting an</p><p>integrative review.</p><p>Corresponding author:</p><p>Shannon Dhollande, University of the Sunshine Coast, Caboolture Campus, Tallon Street, Cabolture, Queensland 4510,</p><p>Australia.</p><p>Email: shannon.dhollande@usc.edu.au</p><p>Journal of Research in Nursing</p><p>2021, Vol. 26(5) 427–438</p><p>! The Author(s) 2021</p><p>Article reuse guidelines:</p><p>sagepub.com/journals-permissions</p><p>DOI: 10.1177/1744987121997907</p><p>journals.sagepub.com/home/jrn</p><p>https://orcid.org/0000-0003-3181-7606</p><p>https://orcid.org/0000-0003-3964-042X</p><p>https://uk.sagepub.com/en-gb/journals-permissions</p><p>https://doi.org/10.1177/1744987121997907</p><p>journals.sagepub.com/home/jrn</p><p>http://crossmark.crossref.org/dialog/?doi=10.1177%2F1744987121997907&domain=pdf&date_stamp=2021-08-05</p><p>Keywords</p><p>integrative literature review, methodology research, nursing, research design</p><p>Background</p><p>A literature review is a critical analysis of published research literature based on a specified topic</p><p>(Pluye et al., 2016). Literature reviews identify literature then examine its strengths and</p><p>weaknesses to determine gaps in knowledge (Pluye et al. 2016). Literature reviews are an</p><p>integral aspect of research projects; indeed, many reviews constitute a publication in</p><p>themselves (Snyder, 2019). There are various types of literature reviews based largely on the</p><p>type of literature sourced (Cronin et al. 2008). These include systematic literature reviews,</p><p>traditional, narrative and integrative literature reviews (Snyder, 2019). Aveyard and Bradbury-</p><p>Jones (2019) found more than 35 commonly used terms to describe literature reviews. Within</p><p>healthcare, systematic literature reviews initially gained traction and widespread support because</p><p>of their reproducibility and focus on arriving at evidence-based conclusions that could influence</p><p>practice and policy development (Boell and Cecez-Kecmanovic, 2015). Yet, it became apparent</p><p>that healthcare-related treatment options needed to review broader spectrums of research for</p><p>treatment options to be considered comprehensive, holistic and patient orientated (Boell and</p><p>Cecez-Kecmanovic, 2015). Stern et al. (2014) suggest that despite the focus in healthcare on</p><p>quantitative research not all pertinent questions surrounding the provision of care can be</p><p>answered from this approach. To devise solutions to multidimensional problems, all forms of</p><p>trustworthy evidence need to be considered (Stern et al. 2014).</p><p>Integrative reviews assimilate research data from various research designs to reach</p><p>conclusions that are comprehensive and reliable (Soares et al. 2014). For example, an</p><p>integrative review considers both qualitative and quantitative research to reach its</p><p>conclusions. This approach promotes the development of a comprehensive understanding of</p><p>the topic from a synthesis of all forms of available evidence (Russell, 2005; Torraco, 2005). The</p><p>strengths of an integrative review include its capacity to analyse research literature, evaluate</p><p>the quality of the evidence, identify knowledge gaps, amalgamate research from various</p><p>research designs, generate research questions and develop theoretical frameworks (Russell,</p><p>2005). Aveyard and Bradbury-Jones (2019) suggested that integrative reviews exhibit similar</p><p>characteristics to systematic reviews and may therefore be regarded as rigorous.</p><p>Integrative reviews value both qualitative and quantitative research which are built upon</p><p>differing epistemological paradigms. Both types of research are vital in developing the</p><p>evidence base that guides healthcare provision (Leppäkoski and Paavilainen, 2012).</p><p>Therefore, integrative reviews may influence policy development as their conclusions have</p><p>considered a broad range of appropriate literature (Whittemore and Knafl, 2005). An</p><p>integrative approach to evidence synthesis allows healthcare professionals to make better</p><p>use of all available evidence and apply it to the clinical practice environment (Souza et al.</p><p>2010). For example, Aveyard and Bradbury-Jones (2019) found in excess of 12 different</p><p>types of reviews employed to guide healthcare practice. The healthcare profession requires</p><p>both quantitative and qualitative forms of research to establish the robust evidence base that</p><p>enables the provision of evidence-based patient-orientated healthcare.</p><p>Integrative reviews require a specific set of skills to identify and synthesise literature (Boell</p><p>and Cecez-Kecmanovic, 2010). There remains a paucity of literature that provides explicit</p><p>guidance to novice nursing researchers on how to conduct an integrative review and</p><p>428 Journal of Research in Nursing 26(5)</p><p>importantly how to ensure the results and conclusions are both comprehensive and reliable.</p><p>Furthermore, novice nursing researchers may receive little formal training to develop the</p><p>skills required to generate a comprehensive integrative review (Boote and Beile, 2005).</p><p>Aveyard and Bradbury-Jones (2019) also emphasised the limited literature providing</p><p>guidance surrounding integrative reviews. Therefore, novice nursing researchers need to</p><p>rely on published guidance to assist them. In this regard this paper, using an integrative</p><p>review conducted by the authors as a case study, aims to provide a framework for novice</p><p>nursing researchers conducting integrative reviews.</p><p>Developing the framework</p><p>In conducting integrative reviews, the novice nursing researcher may need to employ a</p><p>framework to ensure the findings are comprehensive and reliable (Boell and Cecez-</p><p>Kecmanovic, 2010; Snyder, 2019). A framework to guide novice nursing researchers in</p><p>conducting integrative reviews has been adapted by the authors and will now be described</p><p>and delineated. This framework used various published literature to guide its creation,</p><p>namely works by Aveyard and Bradbury-Jones (2019), Nelson (2014), Stern et al. (2014),</p><p>Whittemore and Knafl (2005), Pluye et al. (2009), Moher et al., (2009) and Attride-Stirling,</p><p>(2001). The suggested framework involves seven steps (Figure 1).</p><p>Step 1: Write the review question</p><p>The review question acts as a foundation for an integrative study (Riva et al. 2012). Yet, a</p><p>review question may be difficult to articulate for the novice nursing researcher as it needs to</p><p>consider multiple factors specifically, the population or sample, the interventions or area</p><p>under investigation, the research design and outcomes and any benefit to the treatment (Riva</p><p>et al. 2012). A well-written review question aids the</p><p>researcher to develop their research</p><p>protocol/design and is of vital importance when writing an integrative review.</p><p>Figure 1. Integrative review framework (Cooke et al. 2012; Riva et al. 2012).</p><p>Dhollande et al. 429</p><p>To articulate a review question there are numerous tools available to the novice nursing</p><p>researcher to employ. These tools include variations on the PICOTs template (PICOT,</p><p>PICO, PIO), and the Spider template. The PICOTs template is an established tool for</p><p>structuring a research question. Yet, the SPIDER template has gained acceptance despite</p><p>the need for further research to determine its applicability to multiple research contexts</p><p>(Cooke et al., 2012). Templates are recommended to aid the novice nursing researcher in</p><p>effectively delineating and deconstructing the various elements within their review question.</p><p>Delineation aids the researcher to refine the question and produce more targeted results</p><p>within a literature search. In the case study, the review question was to: identify, evaluate</p><p>and synthesise current knowledge and healthcare approaches to women presenting due to</p><p>intimate partner violence (IPV) within emergency departments (ED). This review objective is</p><p>delineated in the review question templates shown in Table 1.</p><p>Step 2: Determine the search strategy</p><p>In determining a search strategy, it is important for the novice nursing researcher to consider</p><p>the databases employed, the search terms, the Boolean operators, the use of truncation and</p><p>the use of subject headings. Furthermore, Nelson (2014) suggests that a detailed description</p><p>of the search strategy should be included within integrative reviews to ensure readers are able</p><p>to reproduce the results.</p><p>The databases employed within a search strategy need to consider the research aim and</p><p>the scope of information contained within the database. Many databases vary in their</p><p>coverage of specific journals and associated literature, such as conference proceedings</p><p>(Boell and Cecez-Kecmanovic, 2010). Therefore, the novice nursing researcher should</p><p>consult several databases when conducting their searches. For example, search strategies</p><p>within the healthcare field may utilise databases such as Cumulative Index to Nursing and</p><p>Allied Healthcare Literature (CINAHL), Cochrane Library, Science Direct, ProQuest, Web</p><p>of Science, Scopus and PsychInfo (Cronin et al. 2008). These databases among others are</p><p>Table 1. Comparison of elements involved with a PICOTS and SPIDER review question.</p><p>PICOTS template</p><p>Population Healthcare professionals</p><p>Intervention/Interest Provision of healthcare to women</p><p>Comparison or Context No comparator</p><p>Emergency department context</p><p>Outcome Any outcomes</p><p>Time No restriction on date of publication was employed to conform to</p><p>the comprehensive approach utilised.</p><p>Study design Integrative: both quantitative and qualitative studies included</p><p>SPIDER template</p><p>Sample Healthcare professionals within the emergency setting</p><p>Phenomenon of Interest Provision of healthcare to women</p><p>Design Integrative</p><p>Evaluation Any outcomes</p><p>Research Type Integrative: both quantitative and qualitative studies included</p><p>(Cooke et al. 2012; Riva et al. 2012).</p><p>430 Journal of Research in Nursing 26(5)</p><p>largely considered appropriate repositories of reliable data that novice researchers may</p><p>utilise when researching within healthcare. The date in which the searches are undertaken</p><p>should be within the search strategy as searches undertaken after this date may generate</p><p>increased results in line with the publication of further studies.</p><p>Utilising an established template to generate a research question allows for the delineation</p><p>of key elements within the question as seen above. These key elements may assist the novice</p><p>nursing researcher in determining the search terms they employ. Furthermore, keywords on</p><p>published papers may provide the novice nursing researcher with alternative search terms,</p><p>synonyms and introduce the researcher to key terminology employed within their field (Boell</p><p>and Cecez-Kecmanovic, 2010). For example, within the case study undertaken the search</p><p>terms included among others: ‘domestic violence’, ‘domestic abuse’, ‘intimate partner</p><p>violence and/or abuse’. To refine the search to the correct healthcare environment the</p><p>terms ‘emergency department’ and/or ‘emergency room’ were employed. To link search</p><p>terms, the researcher should consider their use of Boolean operators ‘And’ ‘Or’ and ‘Not’</p><p>and their use of truncation (Cronin et al. 2008). Truncation is the shortening of words which</p><p>in literature searches may increase the number of search results. Medical subject headings</p><p>(MeSH) or general subject headings should be employed where appropriate and within this</p><p>case study the headings included ‘nursing’, ‘domestic violence’ and ‘intimate partner</p><p>violence’.</p><p>Inclusion and exclusion criteria allow the novice nursing researcher to reduce and refine</p><p>the search parameters and locate the specific data they seek. Appropriate use of inclusion</p><p>and exclusion criteria permits relevant data to be sourced as wider searches can produce a</p><p>large amount of disparate data, whereas a search that is too narrow may result in the</p><p>omission of significant findings (Boell and Cecez-Kecmanovic, 2010). The novice nursing</p><p>researcher needs to be aware that generating a large volume of search results may not</p><p>necessarily result in relevant data being identified. Within integrative reviews there is</p><p>potential for a large volume of data to be sourced and therefore time and resources</p><p>required to complete the review need to be considered (Heyvaert et al. 2017). The analysis</p><p>and refining of a large volume of data can become a labour-intensive exercise for the novice</p><p>nursing researcher (Boell and Cecez-Kecmanovic, 2010).</p><p>Stern et al. (2014) suggest various elements that should be considered within inclusion/</p><p>exclusion criteria:</p><p>. the type of studies included;</p><p>. the topic under exploration;</p><p>. the outcomes;</p><p>. publication language;</p><p>. the time period; and</p><p>. the methods employed.</p><p>The use of limiters or exclusion criteria are an effective method to manage the amount</p><p>of time it takes to undertake searches and limit the volume of research generated.</p><p>Yet, exclusion criteria may introduce biases in the search results and should therefore be</p><p>used with caution and to produce specific outcomes by the novice nursing researcher</p><p>(Hammerstrøm et al. 2017).</p><p>Whittemore and Knafl (2005) suggest that randomised controlled trials, prospective and</p><p>retrospective cohort studies, case control studies, cross sectional studies, systematic reviews</p><p>Dhollande et al. 431</p><p>and meta-analyses should all be included within the search strategy. Therefore, there are no</p><p>biases based on the type of publication sourced (Hammerstrøm et al. 2017).</p><p>There should be no restriction on the sample size within the studies recognising that</p><p>qualitative studies generally have smaller sample sizes, and to capture the breadth of</p><p>research available. There was no restriction on the date of publication within the case</p><p>study as quality literature was limited. Scoping widely is an important strategy within</p><p>integrative reviews to produce comprehensive results. A manual citation search of the</p><p>reference list of all sourced papers was also undertaken by a member of the research team.</p><p>Literature may be excluded if those papers were published in a language foreign to</p><p>the researcher with no accepted translation available. Though limiting papers based on</p><p>translation availability may introduce some bias, this does ensure the review remains</p><p>free from translational errors and cultural misinterpretations. In the case study, research</p><p>conducted in developing countries with a markedly different healthcare service and</p><p>significant resource limitations were excluded due to their lack of generalisability and</p><p>clinical relevance; though this may have introduced a degree of location bias (Nelson, 2014).</p><p>A peer review of the search strategy by an individual who specialises in research data</p><p>searches such as a research librarian may be</p><p>a viable method in which the novice</p><p>healthcare researcher can ensure the search strategy is appropriate and able to</p><p>generate the required data. One such tool that a novice nurse may employ is the</p><p>Peer Review of the Search Strategy (PRESS) checklist. A peer review of the caste</p><p>study was undertaken by a research librarian. All recommendations were incorporated</p><p>into the search strategy which included removing a full text limiter, and changes to the</p><p>Boolean and proximity operators.</p><p>After the search strategy has been implemented the researcher removes duplicate results</p><p>and screened the retrieved publications based on their titles and abstracts. A second</p><p>screening was then undertaken based on the full text of retrieved publications to remove</p><p>papers that were irrelevant to the research question. Full text copies should then be obtained</p><p>for critical appraisal employing validated methods.</p><p>Step 3: Critical appraisal of search results</p><p>The papers identified within the search strategy should undergo a critical appraisal to</p><p>determine if they are appropriate and of sufficient quality to be included within the</p><p>review. This should be conducted or reviewed by a second member of the research team,</p><p>which occurred within this case study. Any discrepancies were discussed until consensus was</p><p>achieved. A critical appraisal allows the novice healthcare researcher to appraise the</p><p>relevance and trustworthiness of a study and, therefore, determine its applicability to their</p><p>research (CASP, 2013). There are several established tools a novice nurse can employ in</p><p>which to structure their critical appraisal. These include the Scoring System for Mixed-</p><p>Methods Research and Mixed Studies Reviews developed by Pluye et al. (2009) and the</p><p>Critical Appraisal Skills Programme (CASP, 2018) Checklists.</p><p>The review undertaken by the authors employed the scoring system for mixed-methods</p><p>research and mixed-studies reviews developed by Pluye et al. (2009). This scoring system was</p><p>specifically designed for reviews employing studies from various research designs and</p><p>therefore was utilised with ease (Table 2).</p><p>Using the CASP checklist aids the novice nursing researcher to examine the methodology</p><p>of identified papers to establish validity. This critical appraisal tool contains 10 items. These</p><p>432 Journal of Research in Nursing 26(5)</p><p>items are yes or no questions that assist the researcher to determine (a) if the results of the</p><p>paper are valid, (b) what the results are and (c) if it is relevant in the context of their study.</p><p>For example, the checklist asks the researcher to consider the presence of a clear statement</p><p>surrounding the aims of the research, and to consider why and how the research is important</p><p>in regard to their topic (CASP, 2013). This checklist supports the nurse researcher to assess</p><p>the validity, results and significance of research, and therefore appropriately decide on its</p><p>inclusion within the review (Krainovich-Miller et al., 2009).</p><p>Step 4: Summarise the search results</p><p>A summary of the results generated by literature searches is important to exemplify how</p><p>comprehensive the literature is or conversely to identify if there are gaps in research. This</p><p>summary should include the number of, and type of papers included within the review post</p><p>limiters, screening and critical appraisal of search results. For example, within the review</p><p>detailed throughout this paper the search strategy resulted in the inclusion of 25 qualitative</p><p>and six quantitative papers (Bakon et al. 2019). Many papers provide a summary of their</p><p>search results visually in a Preferred Reporting Items for Systematic Reviews and Meta-</p><p>Analyses (PRISMA) flow diagram (Boell and Cecez-Kecmanovic, 2015). PRISMA is a</p><p>method of reporting that enables readers to assess the robustness of the results (Leclercq</p><p>et al. 2019; Moher et al. 2009). PRISMA promotes the transparency of the search process by</p><p>delineating various items within the search process (Leclercq et al. 2019; Moher et al. 2009).</p><p>Researchers may decide how rigorously they follow this process yet should provide a</p><p>rationale for any deviations (Leclercq et al. 2019; Moher et al, 2009). Figure 2 is an</p><p>example of the PRISMA flow diagram as it was applied within the case study.</p><p>Table 2. The scoring system for mixed-methods research and mixed-studies reviews (Pluye et al. 2009).</p><p>Types of mixed-methods</p><p>study components Methodological quality criteria</p><p>Present/Not</p><p>Y/N</p><p>Qualitative Qualitative objective or question</p><p>Appropriate qualitative approach or design or method</p><p>Description of the context</p><p>Description of participants and justification of sampling</p><p>Description of qualitative data collection and analysis</p><p>Discussion of researchers’ reflexivity</p><p>Quantitative</p><p>experimental</p><p>Appropriate sequence generation and/or randomisation</p><p>Allocation concealment and/or blinding</p><p>Complete outcome data and/or low withdrawal/</p><p>drop-out</p><p>Quantitative</p><p>observational</p><p>Appropriate sampling and sample</p><p>Justification of measurements (validity and standards)</p><p>Control of confounding variables</p><p>Mixed Methods Justification of the mixed-methods design</p><p>Combination of qualitative and quantitative data</p><p>collection-analysis techniques or procedures</p><p>Integration of qualitative and quantitative data or results</p><p>Dhollande et al. 433</p><p>Step 5: Data extraction and reduction</p><p>Data can be extracted from the critically appraised papers identified through the search strategy</p><p>employing extraction tables. Within the case study data were clearly delineated, as suggested</p><p>by Boell and Cecez-Kecmanovic (2010), into extraction or comparison tables (Table 3).</p><p>These tables specify the authors, the date of publication, year of publication, site where the</p><p>research was conducted and the key findings. Setting out the data into tables facilitates the</p><p>comparison of these variables and aids the researcher to determine the appropriateness of the</p><p>papers’ inclusion or exclusion within the review (Whittemore and Knafl, 2005).</p><p>Figure 2. Example PRISMA flow diagram (Bakon et al. 2019; Moher et al. 2009).</p><p>Table 3. Example of a data extraction table.</p><p>Author Year Design Sample/Site Findings</p><p>Fanslow et al. 1998 Evaluation Aus, NZ Institutional change is paramount for long</p><p>term improvements in the care provided to</p><p>intimate partner violence patients.</p><p>434 Journal of Research in Nursing 26(5)</p><p>Step 6: Analysis</p><p>Thematic analysis is widely used in integrative research (Attride-Stirling, 2001). In this</p><p>section we will discuss the benefits of employing a structured approach to thematic</p><p>analysis including the formation of a thematic network. A thematic network is a visual</p><p>diagram or depiction of the themes displaying their interconnectivity. Thematic analysis</p><p>with the development of a thematic network is a way of identifying themes at various</p><p>levels and depicting the observed relationships and organisation of these themes (Attride-</p><p>Stirling, 2001). There are numerous methods and tools available in which to conduct a</p><p>thematic analysis that may be of use to the novice healthcare researcher conducting an</p><p>integrative review. The approach used in a thematic analysis is important though a</p><p>cursory glance at many literature reviews will reveal that many authors do not delineate</p><p>the methods they employ. This includes the thematic analysis approach suggested by</p><p>Thomas and Harden (2008) and the approach to thematic networking suggested by</p><p>Attride-Stirling (2001).</p><p>Thomas and Harden (2008) espouse a three-step approach to thematic analysis which</p><p>includes: (a) coding, (b) organisation of codes into descriptive themes, and (c) the</p><p>amalgamation of descriptive themes into analytical themes. The benefit of this approach</p><p>lies in its simplicity and the ease with which a novice nurse researcher can apply the required</p><p>steps. In contrast, the benefit of the approach suggested by Attride-Stirling (2001) lies in its</p><p>ability to move beyond analysis and generate a visual thematic network which facilitates a</p><p>critical interpretation and synthesis of the data.</p><p>Thematic networks typically depict three</p><p>levels: basic themes, organising themes</p><p>and global themes (Attride-Stirling, 2001). The thematic network can then be developed.</p><p>A thematic network is a visual depiction that appears graphically as a web like</p><p>design (Attride-Stirling, 2001). Thematic networks emphasise the relationships and</p><p>interconnectivity of the network. It is an illustrative tool that facilitates interpretation of</p><p>the data (Attride-Stirling, 2001).</p><p>The benefits of employing a thematic analysis and networking within integrative reviews</p><p>is the flexibility inherent within the approach, which allows the novice nursing researcher to</p><p>provide a comprehensive accounting of the data (Nowell et al. 2017). Thematic analysis is</p><p>also an easily grasped form of data analysis that is useful for exploring various perspectives</p><p>on specific topics and highlighting knowledge gaps (Nowell et al. 2017). Thematic analysis</p><p>and networking is also useful as a method to summarise large or diversified data sets to</p><p>produce insightful conclusions (Attride-Stirling, 2001; Nowell et al. 2017). The ability to</p><p>assimilate data from various seemingly disparate perspectives may be challenging for the</p><p>novice nursing researcher conducting an integrative review yet this integration of data by</p><p>thematic analysis and networking was is integral.</p><p>To ensure the trustworthiness of results, novice nursing researchers need to clearly</p><p>articulate each stage within the chosen method of data analysis (Attride-Stirling, 2001;</p><p>Nowell et al. 2017). The method employed in data analysis needs to be precise and</p><p>exhaustively delineated (Attride-Stirling, 2001; Nowell et al. 2017). Attride-Stirling (2001)</p><p>suggests six steps within her methods of thematic analysis and networking. These steps</p><p>include:</p><p>(1) code material;</p><p>(2) identify themes;</p><p>(3) construct thematic network;</p><p>Dhollande et al. 435</p><p>(4) describe and explore the thematic network;</p><p>(5) summarise thematic network findings; and</p><p>(6) interpret patterns to identify implications.</p><p>In employing the approach suggested by Attride-Stirling (2001) within the case study the</p><p>coding of specific findings within the data permitted the development of various themes</p><p>(Table 4). Inclusion of both quantitative and qualitative findings within the themes</p><p>facilitated integration of the data which identified patterns and generated insights into the</p><p>current care provided to IPV victims within ED.</p><p>Step 7: Conclusions and implications</p><p>A conclusion is important to remind the reader why the research topic is important. The</p><p>researcher can then follow advice by Higginbottom (2015) who suggests that in drawing and</p><p>writing research conclusions the researcher has an opportunity to explain the significance of</p><p>the findings. The researcher may also need to explain these conclusions in light of the study</p><p>limitations and parameters. Higginbottom (2015) emphasises that a conclusion is not a</p><p>summary or reiteration of the results but a section which details the broader implications</p><p>of the research and translates this knowledge into a format that is of use to the reader. The</p><p>implications of the review findings for healthcare practice, for healthcare education and</p><p>research should be considered.</p><p>Employing this structured and comprehensive framework within the case study the</p><p>authors were able to determine that there remains a marked barrier in the provision of</p><p>healthcare within the ED to women presenting with IPV-related injury. By employing an</p><p>integrative approach multiple forms of literature were reviewed, and a considerable gap was</p><p>identified. Therefore, further research may need to focus on the developing a structured</p><p>healthcare protocol to aid ED clinicians to meet the needs of this vulnerable patient</p><p>population.</p><p>Conclusion</p><p>Integrative reviews can be conducted with success when they follow a structured approach.</p><p>This paper proposes a framework that novice nursing researchers can employ. Applying our</p><p>stepped framework within an integrative review will strengthen the robustness of the study</p><p>and facilitate its translation into policy and practice. This framework was employed by the</p><p>Table 4. Coding and theme formation.</p><p>Article Text Segment Code Theme</p><p>Loughlin</p><p>et al. (2000)</p><p>‘the translation of protocols into</p><p>practice is less well researched.’</p><p>FR-EV Frameworks for</p><p>intimate partner</p><p>violence care</p><p>provision</p><p>Fanslow</p><p>et al. (1998)</p><p>‘while the protocol produced initial</p><p>positive changes in the identification</p><p>and acute management of abused</p><p>women, these changes were not</p><p>maintained.’</p><p>FR-NEG</p><p>436 Journal of Research in Nursing 26(5)</p><p>authors to identify, evaluate and synthesise current knowledge and approaches of health</p><p>professionals surrounding the care provision of women presenting due to IPV within</p><p>emergency departments. The recommendations from the case study are currently being</p><p>translated and implemented into the practice environment.</p><p>Key points for policy, practice and/or research</p><p>. Integrative literature reviews are required within nursing to consider elements of care</p><p>provision from a holistic perspective.</p><p>. There is currently limited literature providing explicit guidance on how to undertake</p><p>an integrative literature review.</p><p>. Clear delineation of the integrative literature review process demonstrates how the</p><p>knowledge base was understood, organised and analysed.</p><p>. Nurse researchers may utilise this guidance to ensure the reliability of their integrative</p><p>review.</p><p>Declaration of conflicting interests</p><p>The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or</p><p>publication of this article.</p><p>Ethics</p><p>Due to the nature of this article this article did not require ethical approval.</p><p>Funding</p><p>The author(s) received no financial support for the research, authorship, and/or publication of this article.</p><p>ORCID iDs</p><p>Shannon Dhollande https://orcid.org/0000-0003-3181-7606</p><p>Silke Meyer https://orcid.org/0000-0003-3964-042X</p><p>References</p><p>Attride-Stirling J (2001) Thematic networks: An analytic tool for</p><p>qualitative research. Qualitative Research 1(3): 385–405.</p><p>Aveyard H and Bradbury-Jones C (2019) An analysis of</p><p>current practices in undertaking literature reviews in nursing:</p><p>Findings from a focused mapping review and synthesis.</p><p>BMC Medical Research Methodology 19(1): 1–9.</p><p>Bakon S, Taylor A, Meyer S, et al. (2019) The provision of</p><p>emergency healthcare for women who experience intimate</p><p>partner violence: Part 1 An integrative review. Emergency</p><p>Nurse 27: 19–25.</p><p>Boell S and Cecez-Kecmanovic D (2010) Literature reviews</p><p>and the Hermeneutic circle. Australian Academic & Research</p><p>Libraries 41(2): 129–144.</p><p>Boell S and Cecez-Kecmanovic D (2015) On being</p><p>systematic in literature reviews. Journal of Information</p><p>Technology 30: 161–173.</p><p>Boote D and Beile P (2005) Scholars before</p><p>researchers: On the centrality of the dissertation</p><p>literature review in research preparation. Educational</p><p>Researcher 34(6): 3–15.</p><p>Cooke A, Smith D and Booth A (2012) Beyond PICO: The</p><p>SPIDER tool for qualitative evidence synthesis. Qualitative</p><p>Health Research 22(10): 1435–1443.</p><p>Critical Appraisal Skills Programme (CASP) (2018) CASP</p><p>Checklists. casp-uk.net/casp-tools-checklists.</p><p>Dhollande et al. 437</p><p>https://orcid.org/0000-0003-3181-7606</p><p>https://orcid.org/0000-0003-3181-7606</p><p>https://orcid.org/0000-0003-3964-042X</p><p>https://orcid.org/0000-0003-3964-042X</p><p>Cronin P, Ryan F and Coughlan M (2008) Undertaking a</p><p>literature review: A step by step approach. British Journal of</p><p>Nursing 17(1): 38–43.</p><p>Hammerstrøm K, Wade A, Jørgensen A, et al. (2017) Searching</p><p>for relevant studie. In: Heyvaert M, Hannes K and Onghena P</p><p>(eds) Using Mixed Methods Research Synthesis for Literature</p><p>Reviews. Thousand Oaks, CA: SAGE, pp. 69–112.</p><p>Heyvaert M, Maes B, Onghena P, et al. (2017) Introduction to</p><p>MMRS literature reviews. In: Heyvaert M, Hannes K and</p><p>Onghena P (eds) Using Mixed Methods Research Synthesis for</p><p>Literature Reviews. Thousand Oaks, CA: SAGE, pp. 1–22.</p><p>Higginbottom G (2015) Drawing conclusions from your</p><p>research. In: Higginbottom G and Liamputtong P (eds)</p><p>Participatory</p><p>Qualitative Research Methodologies in Health.</p><p>London: SAGE, pp. 80–89.</p><p>Krainovich-Miller B, Haber J, Yost J, et al. (2009) Evidence-</p><p>based practice challenge: Teaching critical appraisal of</p><p>systematic reviews and clinical practice guidelines to</p><p>graduate students. Journal of Nursing Education 48(4):</p><p>186–195.</p><p>Leclercq V, Beaudart C, Ajamieh S, et al. (2019) Meta-analyses</p><p>indexed in PsycINFO had a better completeness of reporting</p><p>when they mention PRISMA. Journal of Clinical</p><p>Epidemiology 115: 46–54.</p><p>Leppäkoski T and Paavilainen E (2012) Triangulation as a</p><p>method to create a preliminary model to identify and</p><p>intervene in intimate partner violence. Applied Nursing</p><p>Research 25: 171–180.</p><p>Moher D, Liberati A, Tetzlaff J, et al. (2009) Preferred</p><p>reporting items for systematic reviews and meta-analyses:</p><p>The PRISMA Statement. PLoS Med 6(7): e1000097.</p><p>Nelson H (2014) Systematic Reviews to Answer Health Care</p><p>Questions. Philadelphia, PA: Wolters Kluwer Health.</p><p>Nowell L, Norris J, White D, et al. (2017) Thematic analysis.</p><p>International Journal of Qualitative Methods 16(1): 1–13.</p><p>Pluye P, Gagnon M, Griffiths F, et al. (2009) A scoring system</p><p>for appraising mixed methods research, and concomitantly</p><p>appraising qualitative, quantitative and mixed methods</p><p>primary studies in mixed studies reviews. International</p><p>Journal of Nursing Studies 46: 529–546.</p><p>Pluye P, Hong Q, Bush P, et al. (2016) Opening up the</p><p>definition of systematic literature review: The plurality of</p><p>worldviews, methodologies and methods for reviews and</p><p>syntheses. Journal of Clinical Epidemiology 73: 2–5.</p><p>Riva JJ, Malik KM, Burnie SJ, et al. (2012) What is your</p><p>research question? An introduction to the PICOT format for</p><p>clinicians. The Journal of the Canadian Chiropractic</p><p>Association 56(3): 167–171.</p><p>Russell C (2005) An overview of the integrative research</p><p>review. Progress in Transplantation 15(1): 8–13.</p><p>Snyder H (2019) Literature review as a research methodology:</p><p>An overview and guidelines. Journal of Business Research</p><p>104: 333–339.</p><p>Soares C, Hoga L, Peduzzi M, et al. (2014) Integrative review:</p><p>Concepts and methods used in nursing. Revista da Escola de</p><p>Enfermagem da USP 48(2): 335–345.</p><p>Souza M, Silva M and Carvalho R (2010) Integrative review:</p><p>What is it? How to do it? Einstein 8(1): 102–106.</p><p>Stern C, Jordan Z and McArthur A (2014) Developing the</p><p>review question and inclusion criteria. American Journal of</p><p>Nursing 114(4): 53–56.</p><p>Thomas J and Harden A (2008) Methods for the thematic</p><p>synthesis of qualitative research in systematic reviews. BMC</p><p>Medical Research Methodology 8: 45.</p><p>Torraco R (2005) Writing integrative literature reviews:</p><p>Guidelines and examples. Human Resource Development</p><p>Review 4(3): 356–367.</p><p>Whittemore R and Knafl K (2005) The integrative review:</p><p>Updated methodology. Journal of Advanced Nursing 52(5):</p><p>546–553.</p><p>Shannon Dhollande is a Lecturer, registered nurse and researcher. Her research explores the</p><p>provision of emergency care to vulnerable populations.</p><p>Annabel Taylor is a Professorial Research Fellow at CQ University who with her</p><p>background in social work explores methods of addressing gendered violence such as</p><p>domestic violence.</p><p>Silke Meyer is an Associate Professor in Criminology and the Deputy Director of the</p><p>Gender and Family Violence Prevention Centre at Monash University.</p><p>Mark Scott is an Emergency Medical Consultant with a track record in advancing</p><p>emergency healthcare through implementation of evidence-based healthcare.</p><p>438 Journal of Research in Nursing 26(5)</p>