Review of Methodological Quality of Systematic and Integrative Reviews in Nursing

Friday, 28 July 2017

Coleen E. Toronto, PhD, RN, CNE
School of Nursing, Curry College, Milton, MA, USA
Ruth Remington, PhD, RN, AGPCNP-BC
Department of Nursing, Framingham State University, Framingham, MA, USA
Brenna Quinn, PhD, RN, NCSN, CNE
School of Nursing, University of Massachusetts Lowell, Lowell, MA, USA

Purpose: This review describes the methodological quality of systematic and integrative reviews in current nursing literature.

Methods:  The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (Moher et al., 2009) directed the methodological review for this study. A critical review of nursing reviews published between 2013 and 2015 was conducted. The Cumulative Index of Nursing and Allied Health Literature (CINAHL) database was searched with the terms integrative review “OR” systematic review. Inclusion criteria were: 1) systematic or integrative reviews; 2) search strategy described and 3) published between 2013 and 2015. Limiters applied include: 1) abstract available; 2) written in English; 3) research article; and 4) first author is nurse. Articles were excluded from review if the following exclusion criteria were met: consensus reports, quality improvement projects, concept analyses, research briefs, conference proceedings, policies/guidelines, original research, and clinical articles.

Results: Initially 190 abstracts were reviewed electronically for relevance and then full-text articles were obtained and inspected for required study criteria. Three investigators rated inclusion criteria independently (CT, RR, and BQ) and reached consensus. After each article was independently reviewed then a second investigator assessed each article with a reported 97.87% agreement. For the lack of consensus for 2.13% articles, a third party adjudicator was consulted. Following identification of articles for inclusion, data regarding the systematic review process of each article was extracted. Twenty-three categories of data were extracted in order to identify characteristics of published literature reviews in nursing. A review matrix was used to systematically organize, analyze, and synthesize methods utilized by authors in the included studies. Data were extracted by investigators independently, and then compared by a second investigator and third party adjudicator in the event of disagreement. A total of 11.2% of selected reviews required third party review. Additionally, all three researchers independently reviewed a random sample of 10% of the articles. One hundred fifty one reviews met inclusion criteria. The sample revealed inconsistency in methods used in these reviews. Many of the searches performed were not replicable or exhaustive. Reviews often did not include inclusion and exclusion criteria or perform quality appraisals of included studies. Nearly half of the studies used only electronic databases to identify studies to include.

Conclusion:  Findings suggest that methodological quality remains a concern. In an international sample of nursing reviews lack of conceptual clarity regarding similarities and differences between systematic reviews and integrative reviews is an issue that needs to be addressed in nursing. This review supports the need for stronger educational preparation of nurses and nursing students in graduate programs on how to conduct an integrative or systematic review (American Association of Colleges of Nursing, 2010). Clear definitions and procedures will help to ensure efficient and rigorous searches that produce strong conclusions that will strengthen the evidence for practice.