Content area
Aim/Objective
To empower nursing graduate students, in master’s or doctoral programs, through distance-accessible methods for conducting integrative reviews, enhancing their ability to transition from clinical to publication-oriented writing.
BackgroundMastering literature review methods is vital for advancing evidence-based practice. Integrative reviews, inclusive of multiple research methodologies, offer a comprehensive approach suited for nursing students. However, transitioning from clinical to publication-oriented writing poses challenges, necessitating innovative solutions.
DesignThis discussion presents strategic writing methods, including technologies for distance-accessible collaboration and data organization, framework use and critical analysis skills to support nursing graduate students in conducting integrative reviews.
MethodsApproaches for preparing and developing an integrative review are outlined, including integrating online tools and collaborative platforms and structured frameworks to guide data organization and critical analysis. Two published integrative reviews exemplifying these approaches are presented.
ResultsDistance-accessible and strategic approaches have significantly improved the quality of integrative literature reviews conducted by nursing graduate students. These innovations have equipped students with essential skills for navigating the contemporary academic landscape.
ConclusionsEmbracing innovative approaches and staying informed about technological advancements empowers nursing graduate students to excel in their research pursuits. This contributes to evidence-based practice and nursing scholarship in the evolving healthcare landscape.
In the dynamic landscape of healthcare and nursing, rigorous academic inquiry is essential for advancing evidence-based practice. Mastering the art of conducting literature reviews is crucial for master’s and doctoral level nursing graduate students. Literature reviews serve as vital connectors, linking current knowledge with unexplored territories and shaping the trajectory of research and practice ( Munn et al., 2018). Navigating the literature review landscape can be daunting due to the myriad of methods available.
Literature reviews take various forms, from narrative reviews offering descriptive snapshots to systematic reviews following strict protocols ( Grant and Booth, 2009; Gough et al., 2012). Integrative reviews stand out for their inclusive approach—blending empirical and theoretical literature--providing a holistic understanding ( Whittemore and Knafl, 2005; Torraco, 2016). By encompassing both qualitative and quantitative literature, integrative reviews provide an appealing framework for graduate nursing students.
2 BackgroundDespite the critical role of scholarly writing in graduate nursing education, many students encounter challenges transitioning from clinical writing to publication-oriented work ( Dowling et al., 2013; Gazza and Hunker, 2012; Gazza et al., 2013; Vance et al., 2020). Although publishing may not be an immediate priority, students are encouraged to share their research findings through dissemination. A common starting point for graduate students is the development of a comprehensive literature review, systematically crafted with the intention of eventual publication.
While faculty mentorship is invaluable in guiding students through this process, it is not always readily accessible due to factors such as faculty turnover, limited expertise in specific topics or methodologies and competing professional responsibilities ( Cleary et al., 2023; Lee et al., 2023). Fortunately, advancements in technology have created innovative solutions to support graduate nursing students in developing their writing skills and pursuing publication ( Clement and Welch, 2021; Jordan et al., 2021; Rohan and Fullerton, 2020; Tyndall et al., 2019).
Expedited by the COVID-19 restrictions, distance-accessible learning methods (hybrid and remote) have gained prevalence in graduate nursing education, offering a viable pathway for preparing future nurse leaders ( Broome et al., 2011; Gray and Crosta, 2019; Halter et al., 2006; Leaver et al., 2022). These programs offer students the advantages of access to multiple academic institutions without necessitating relocation, flexible scheduling and the capacity to balance professional commitments with educational pursuits ( Gray and Crosta, 2019). Furthermore, technology resources, such as cloud-based file-sharing, videoconferencing and online reference management tools, have reshaped virtual learning environments, fostering increased collaboration between institutions, facilitating academic writing mentorship and providing real-time feedback for students' experiential learning ( Al-Samarraie and Saeed, 2018; Lee et al., 2023).
Given that conducting a thorough literature review for publication can be a challenge for novice graduate nursing students, acquiring the requisite skills and resources becomes essential ( Gazza et al., 2013). Here, we discuss strategic writing methods aimed at teaching graduate nursing students how to navigate the intricacies of conducting and publishing an integrative literature review. We outline the use of distance-accessible online methods, such as cloud-based file-sharing, videoconferencing, online data management tools. Throughout the implementation section, we will exemplify the use of these strategies, drawing insights from two successfully published integrative reviews Ansari et al. (2022) and Pitts et al. (2023), which were authored by graduate nursing students ( Table 1) . This discussion, exploring the characteristics, methodological considerations, practical steps and potential challenges associated with integrative reviews, aims to equip students with knowledge, skills and strategies to elevate their research proficiency and contributions to nursing scholarship.
2.1 Strategic writing methodsTo achieve a successful integrative review, developing effective writing habits and skill sets is essential. This section discusses strategic writing methods that enhance literature review and writing skills, emphasizing the crucial role of distance-accessible technologies, framework use, data organization and critical data analysis.
2.2 Distance-accessible technologiesMentorship and team meetings play a pivotal role in developing rigorous, high-quality reviews by graduate student authors. However, in recent years, the COVID-19 restrictions prohibited in-person gatherings due to safety precautions. Moreover, the increasing frequency of distance-accessible doctoral programs renders it impractical to hold face-to-face meetings consistently, given the geographical dispersion of students and faculty. Online technologies, like Zoom ( Zoom Video Communications, 2024) and Microsoft Teams ( Microsoft, 2024d), to name a few, allow students and their faculty members to meet online, facilitating communication, instruction and collaboration. In addition to video conferencing, integrating cloud-based file storage is imperative for ensuring smooth remote collaboration on manuscripts. Platforms like Box ( Box, 2024), One Drive ( Microsoft, 2024c), or Google Docs ( Google, 2024b) facilitate simultaneous updates by multiple users, enhancing efficiency and coordination in document editing.
Similarly, reference management software technology has advanced to enable remote collaboration with shared libraries among project teams and collaborators. Leading reference management programs, such as EndNote ( Clarivate, 2024), Sciwheel ( Sage, 2024), Mendeley ( Elsevier, 2024) and Zotero ( Corporation for Digital Scholarship, 2024) provide cloud-based storage and collaboration features for seamless information exchange. These applications integrate with word processing applications such as Microsoft Word ( Microsoft, 2024a), Google Docs ( Google, 2024b) and LibreOffice ( Mozilla, 2024b), simplifying bibliography development and ensuring smooth transitions between different referencing styles. Furthermore, internet browsers, such as Microsoft Edge ( Microsoft, 2024b), Google Chrome ( Google, 2024a), Apple Safari ( Apple, 2024) and Mozilla Firefox ( Mozilla, 2024a), offer extensions for reference management software, allowing users to import citations directly from reference libraries, database searches and websites. Multiple cloud-based reference management solutions exist to ease the collaborative sharing of reference data. Options for shared reference management are outlined in Table 2.
Tools for developing and collaborating on systematic reviews, such as Covidence ( Covidence, 2024), Rayyan ( Rayyan, 2022), DistillerSR ( DistillerSR, 2024) and JBI SUMARI ( JBI, 2024), streamline data management tasks. These applications facilitate title and abstract screening, full-text screening, data abstraction and quality assessment. Moreover, some platforms incorporate artificial intelligence (AI) algorithms to assist users in identifying and screening literature, enhancing the review process's comprehensiveness. Many of these programs also integrate with review guidelines, such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework ( Page et al., 2021), to ensure adherence to systematic review standards.
Unlike the others, AI stands as a controversial yet imminent aspect of contemporary scientific writing that educators must acknowledge ( Awosanya et al., 2024; Kacena et al., 2024). To prepare students for this evolving landscape, educators should emphasize the responsible use of AI, educating students on leveraging AI capabilities to enhance the rigor and authenticity in their work while cautioning against plagiarism ( Salvagno et al., 2023). Notably, AI has long played a role in scientific writing, from basic spell-checking to more advanced grammar and plagiarism detection within word processing programs. Today, AI tools offer comprehensive support, assisting writers in grammar, spelling, sentence structure, formatting, tone, style, vocabulary and clarity ( AIContentfy, 2023). Artificial intelligence can also provide contextual suggestions and proofreading assistance, fostering better writing skills and enhancing the readability of scientific texts. Nonetheless, users should exercise caution when employing AI in scientific writing, emphasizing the importance of fact-checking ( Awosanya et al., 2024; Kacena et al., 2024). Furthermore, authors must disclose the use of AI technologies in scientific manuscripts, as mandated by most scientific journals. Several AI technologies and their use in scientific writing are outlined in Table 3.
2.3 Framework useThe methodology for conducting integrative literature reviews typically commences with selecting a relevant conceptual framework ( Baethge et al., 2019). Frameworks are instrumental in delineating the review's scope, specifying key concepts, variables and relationships to be explored ( Hsieh and Shannon, 2005). Using the chosen framework, researchers can derive keywords, ensuring a targeted and focused literature search with comprehensive and relevant results ( Anderson et al., 2008; Daudt et al., 2013). This approach minimizes the risk of overlooking crucial studies and ensures a balanced coverage of the literature.
Frameworks also assist in establishing inclusion and exclusion criteria, aligning studies with research objectives for improved quality and relevance ( Baethge et al., 2019). They further enable the synthesis and analysis of literature by providing structured guidance for categorizing and comparing studies ( Hsieh and Shannon, 2005).
While framework-guided reviews have their merits, they may not always be practical. Alternatively, the integrative review allows researchers the flexibility of framework development through literature synthesis. This approach proves essential in emerging fields lacking established frameworks, allowing researchers to navigate novel areas of science effectively. In this case, the clinical question guides the literature search and eligibility criteria. This is often achieved through use of a Population/Problem (P), Intervention (I), Comparison (C) and Outcome (O), or PICO approach ( Schardt et al., 2007).
2.4 Data organizationA systematic approach is emphasized in data organization, aligning each article's content for effective management. Thorough review, extraction and categorization of pertinent information facilitate pattern identification, connection and gap analysis within the body of research. After conducting a literature search, data sorting involves identifying and removing duplicate resources, followed by screening titles and abstracts based on inclusion and exclusion criteria. Recent advancements have seen a transition to cloud-based applications for the storage and screening of literature, enhancing distance-accessible collaboration. Systematic review software like Covidence ( Covidence, 2024), Rayyan ( Rayyan, 2022), DistillerSR ( DistillerSR, 2024), can assist in the entire review process, including the automation of reporting templates like PRISMA ( Page et al., 2021). These technologies allow multiple researchers to tag and notate references, which can streamline and add transparency to the screening process.
2.5 Critical data analysisA rigorous integrative review includes a critical analysis of the included literature. This is a two-step process. First, articles are assessed for their level of evidence. The hierarchy of evidence is a framework used in evidence-based medicine and research to rank the generalizability and reliability of research studies ( Dang et al., 2022; Fineout-Overholt et al., 2010). Traditionally, the hierarchy of evidence ranks systematic reviews and meta-analyses as having the highest level of evidence, followed in descending order by randomized controlled trials, cross-sectional and case-control studies, reviews of qualitative or mixed-methods studies, single qualitative or mixed-methods studies, case reports, case series and experiential evidence and expert opinion summaries ( Dang et al., 2022; Fineout-Overholt et al., 2010). This hierarchy has faced criticism for undervaluing qualitative and mixed-methods research, particularly in healthcare ( Jones and Steel, 2018). However, identifying the category of evidence is an essential first step to assessing the research’s quality.
The second step in the critical analysis process includes appraising the quality of the included literature ( Toronto and Remington, 2020). Selecting an appropriate tool to critique the quality of literature can be difficult, especially when reviewing research from various methodologies for an integrative review. While many appraisal tools have been developed, only a selection of these are well suited for appraising both quantitative and qualitative primary research ( Buccheri and Sharifi, 2017). Popular tools for quality appraisal in integrative reviews include the Johns Hopkins evidence appraisal tool ( Dang et al., 2022), the Critical Appraisal Skills Program ( CASP UK, 2024), the Joanna Briggs Institute’s critical appraisal tools ( JBI and The University of Adelaide, 2024), Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criterion ( Balshem et al., 2011) and rapid critical appraisal checklists ( Fineout-Overholt, 2019). Caldwell et al. (2011) also provide a valuable critique framework for novice research consumers.
3 ImplementationWhile these strategic writing methods provide valuable support to graduate nursing students at various stages of conducting an integrative review, their practical application can be challenging to conceptualize. To address this, this section presents two exemplars of integrative reviews completed by graduate nursing students, Ansari et al. (2022) and Pitts et al. (2023), see Table 1 for a side-by-side comparison. By comparing and contrasting the methods used in each review, we will highlight how both approaches are distinct yet effectively aligned with their respective research questions.
Ansari et al.’s (2022) integrative review utilized Epstein and Street's (2007) “Patient-Centered Communication in Cancer Care" framework—recognized for its applicability to healthcare communication—in guiding the systematic search for relevant articles. To initiate the search, the framework served as a comprehensive template, delineating key components and concepts related to patient-centered communication in the context of cancer care. As articles were retrieved, they underwent a meticulous screening process, with inclusion and exclusion criteria closely aligned with the framework's components. This method facilitated categorizing articles into distinct elements of the patient-centered communication framework, contributing to a nuanced understanding of the literature and its relevance to our research objectives.
Employing a deductive approach, Ansari et al.’s (2022) integrative review process was strategically designed to align with Epstein and Street's (2007) framework from the outset. This deductive orientation informed the entire research trajectory, guiding literature search, article selection and data organization. By predetermining the framework, a structured and purposeful investigation was ensured, allowing for a systematic exploration of patient-centered communication in cancer care. This approach enhanced the coherence and relevance of the identified literature, streamlining subsequent steps in the integrative review process.
For data organization, Ansari et al. (2022) adopted innovative strategies to enhance efficiency and collaboration. Utilizing cloud-based applications and tools, such as shared online databases and collaborative platforms, facilitated real-time updates and synchronous remote contributions with research mentors and collaborators. This approach structured the organization of identified articles and provided a centralized space for team members to contribute insights and perspectives collectively.
Pitts et al. (2023) took a more inductive approach in conducting their integrative literature review. For Pitts et al., clinical experience guided the research question (PICO approach), which asked how newborn screening had altered the presentation and treatment of adrenoleukodystrophy (ALD). Literature was systematically searched and included based on inclusion and exclusion criteria focused on a specific clinical presentation of ALD—males with adrenal dysfunction ( Pitts et al., 2023).
A health science librarian was consulted to ensure an exhaustive search of all literature pertaining to the research question. This approach included a wide breadth of both quantitative and qualitative literature in the review, with data relating to the presentation, evaluation and treatment of males with adrenal dysfunction.
No a priori framework guided reviewing the literature; rather, as the literature was reviewed, analyzed and synthesized, themes emerged among the content, which were then used to develop the components of a clinical evaluation and treatment framework for clinicians caring for males with ALD identified through newborn screening ( Pitts et al., 2023).
Multiple strategies were used to organize and analyze the data for this review remotely. Authors (mentors and mentee) collaborated using shared reference management libraries, cloud-based file sharing and videoconferencing to facilitate evaluating and synthesizing themes within the literature. Asynchronous and synchronous access to the data allowed authors to discourse and progress the research on their individual timelines while still maintaining an organized and collective environment for manuscript development.
3.1 Collaborative data management in exemplar reviewsAnsari et al. (2022) conducted their review using a distance-accessible format necessitated by the COVID-19 restrictions, while Pitts et al. (2023) developed their review as part of a synchronous, distance-accessible academic scholarly writing course. In both cases, the ability to collaborate remotely through screen sharing, discussion of articles and mentorship ensured that academic progress was maintained despite physical distance.
A consistent feature in both formats was the use of table and highlighting data management strategies ( Fig. 1), which facilitated data extraction and synthesis. These strategies were effectively employed in both the one-on-one distance-accessible mentorship setting and the didactic university environment. The table and highlighting method serves as a practical tool for guiding students in extracting and synthesizing data.
To further support this process, synthesis versus summarizing was clarified through examples. A commonly used analogy is the fruit salad versus fruit smoothie comparison: summarizing is akin to a fruit salad, where individual pieces (or articles) remain distinct and separable, while synthesizing resembles a smoothie, where the relevant literature is blended together into a cohesive and integrated conclusion.
4 DiscussionThe integration of strategic writing methods integrating distance-accessible technologies reflects a dynamic response to the evolving demands of graduate nursing education. The accelerated adoption of distance-accessible learning methods, particularly amidst the challenges posed by the COVID-19 restrictions, has reshaped the educational experience and influenced how integrative literature reviews are conducted and published. The use of cloud-based collaboration tools, reference management systems and systematic review software has become essential for streamlining efficient and rigorous research processes. Additionally, the growing adoption and advancement of AI technologies hold significant potential to enhance students’ execution of integrative reviews, necessitating both proficiency in these tools and careful consideration of their implementation.
This discussion also underscores the significance of adopting frameworks for guiding literature searches and providing structure to the review process. The deductive and inductive approaches showcased in the examples underscore the necessity for flexibility and adaptability in research methods with the overarching goal of addressing various research questions. Overall, this integration of technology, coupled with strategic methods, not only enhances the quality of integrative literature reviews but also equips nursing graduate students with essential skills for navigating the contemporary academic landscape. By integrating these educational takeaways ( Table 4), nursing graduate students can navigate the complexities of integrative literature reviews while building skills essential for success in today's healthcare and academic environments.
5 ConclusionThe evolving demands of master’s and doctoral graduate nursing education call for innovative strategies in conducting integrative literature reviews. This discussion emphasizes the pivotal role of strategic methods and technological tools—including cloud-based collaboration platforms, reference management systems, systematic review software and AI—in improving research efficiency, particularly within remote learning environments.
Educational takeaways emphasize the importance of embracing technological tools, utilizing conceptual frameworks, recognizing flexibility in research methods, developing critical analysis skills, fostering collaboration and communication and leveraging the expertise of health science librarians. These competencies equip graduate nursing students with the skills to effectively develop integrative literature reviews, contributing to evidence-based practice and nursing scholarship. Embracing innovation and staying informed about technological advancements will empower students to excel in their research pursuits, ultimately shaping the future of healthcare.
Reporting guidelineNot applicable.
FundingNo financial support was received.
CRediT authorship contribution statementNatasha Ansari: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Formal analysis, Conceptualization. Leslie Pitts: Writing – review & editing, Writing – original draft, Visualization, Supervision, Software, Resources, Project administration, Formal analysis, Data curation, Conceptualization. Christina Wilson: Writing – review & editing, Writing – original draft, Supervision, Conceptualization.
Declaration of Competing InterestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
| Reference | Ansari et al. (2022) | Pitts et al. (2023) |
| Purpose | (1) identify articles on technology-based communication strategies aimed at improving health outcomes in individuals with advanced cancer; (2) apply Epstein and Street’s framework to determine areas where such strategies have been utilized to enhance health outcomes; and (3) identify gaps in research and care related to technology-based communication for patients with advanced cancer. | To guide clinicians caring for infants and families with adrenoleukodystrophy (ALD) by examining: (a) the impact of ALD newborn screening on adrenal dysfunction management, (b) insights from states with ALD screening for new implementations, and (c) literature supporting care for women of childbearing age, newly diagnosed infants’ parents, affected family members, and secondarily identified adults. |
| Search Strategy | Articles on technology-based communication strategies improving health outcomes in advanced cancer patients were appraised using Epstein and Street’s framework, which highlights six core communication areas. | Articles were specifically selected to focus on ALD-related adrenal dysfunction in male infants and children identified through newborn screening in the United States. A health science librarian was consulted to inform the database search strategy. |
| Critical Analysis | Two independent reviewers critically appraised studies using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criterion. | Two independent reviewers critically appraised studies using the Adapted Rating System for the Hierarchy of Evidence and the Johns Hopkins Nursing Evidence-Based Practice Guide. |
| Data Synthesis Approach | The studies were organized into a table to extract and evaluate study details. Epstein and Street’s framework guided the analysis. | Data were extracted from each study into a table, then common themes throughout the data were identified. |
| Results | Research was categorized into the six areas of patient-centered communication in cancer care highlighted by Epstein and Street’s framework, identifying gaps in research and care. | A concept map was developed to depict the themes identified within the literature and guide clinicians in caring for individuals impacted by ALD. |
| Strategic Writing Methods Utilized | | |
| Reference Management Software | Sharing Capabilities |
| EndNote | Online or Desktop Options
Share Entire Library Share References or Groups of References |
| Sciwheel | Invite Collaborator to Shared Project |
| Zotero | Private or Public Group Library
Shared Library |
| Mendeley | Private Groups
Generate Link for Collection of References |
| RefWorks | Folder Sharing
Export Files |
| Zbib | Identify Collaborators to Share References |
| Application | Website | Use |
| Grammarly | https://app.grammarly.com/ | Spelling and Grammar Checking
Plagiarism Evaluation |
| Paperpal | https://paperpal.com/ | Editor
Microsoft Word Plugin |
| Turnitin | https://www.turnitin.com/ | Plagiarism Detection Service |
| Consensus | https://consensus.app/ | Responds to Inquiries with References to Published Literature |
| Search Smart | https://searchsmart/org?~() | Identifies Appropriate Databases for Research |
| Elicit | https://elicit.org | Identifies Research, Extracts Data, Summarizes Findings, Brainstorms Ideas |
| Scite | https://scite.ai/ | Search and Evaluate Scientific Articles |
| Lateral | http://www.lateral.io/ | Finds Themes Across Multiple Research Papers |
| ChatGPT | www.chatgpt.com | Topic Refinement, Literature Search Development, Framework and Methodology Guidance, Formatting Assistance, Editing and Proofreading |
| CoPilot | www.copilot.microsoft.com | Identifying Literature Search Terms, Organizing Your Review, Editing and Proofreading, Reference List Formatting |
| Embrace Technological Tools | Familiarize yourself with cloud-based collaboration tools, reference management software, and systematic review platforms. These tools not only streamline the research process but also facilitate effective remote collaboration, which is increasingly relevant in modern healthcare and academia. |
| Framework Utilization | Understand the importance of employing conceptual frameworks in guiding literature searches and organizing data. Frameworks provide a structured approach, ensuring a systematic and purposeful investigation. |
| Flexibility in Research Methodologies | Recognize the value of both deductive and inductive approaches in integrative literature reviews. Be adaptable in choosing methodologies that align with the research question and objectives. |
| Critical Analysis Skills | Develop skills in critically analyzing the level of evidence and appraising the quality of included literature. Familiarize yourself with appraisal tools commonly used in integrative reviews, acknowledging the potential limitations and critiques of hierarchical evidence frameworks. |
| Collaboration and Communication | Emphasize effective communication and collaboration, especially in remote settings. Utilize tools like videoconferencing and screen sharing to enhance mentorship, instruction, and collaborative writing. |
| Utilize Health Science Librarians | Recognize the invaluable support provided by health science librarians in structuring effective search strategies and accessing relevant literature. Collaboration with librarians enhances the depth and comprehensiveness of literature reviews. |
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