(^150) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
An example of a narrative literature review is “The use and application of drama
in nursing education—An integrative review of the literature” (Arveklev, Wigert,
Berg, Burton, & Lepp, 2015), which draws information from published studies
and reports effectiveness of drama in entry-level courses in nursing education.
Integrative Reviews (Level V Evidence)
Integrative reviews are the broadest form of summaries of research evidence.
They summarize evidence that is a combination of research and theoretical
literature and draw from manuscripts using varied methodologies (e.g., experi-
mental, nonexperimental, qualitative). The purpose of an integrative review may
vary widely and include summarizing evidence on a particular topic, reviewing
theories, or defining concepts, among other topics. As with other summaries of
evidence, well-defined and clearly presented search strategies are critical. Because
diverse methodologies may be combined in an integrative review, quality evalua-
tion or further analysis of data is complex. Unlike the literature review, however,
an integrative review analyzes, compares themes, and notes gaps in the selected
literature (Whittemore & Knafl, 2005).
An example of an integrative review is “An Integrative Review of Engaging Clini-
cal Nurses in Nursing Research” (Scala, Price, & Day, 2016), which includes
program evaluations, expert opinions, nonexperimental studies, and other papers
using other methods to examine engaging clinical nurses in nursing research.Interpreting Evidence from Summaries of Research Evidence
Despite efforts to ensure quality, the degree to which CPGs and CSs draw from
existing evidence can fluctuate. Most guidelines are based on systematic reviews
developed by experts whose charge is to arrive at specific clinical conclusions
(IOM, 2001). Additionally, guidelines can lack the specificity needed to ensure
consistent application across patients with the same clinical situation. Because
the evidence base can be limited, or conflicting, the EBP team needs to exercise
critical thinking and judgment when making recommendations.