Integrative Literature Review Secondary Steps


Integrative Literature Reviews (ILR) are the cornerstone of evidence-based practice. The knowledge and practice of developing and publishing an ILR is a vital skill for all graduate prepared nurses. This ILR assignment will provide the opportunity to research an area of interest and provide a basis for securing more in-depth information about a selected nursing education topic. Your ILR research topic must have relevance to your role as a nurse educator. You will use the Guide to Conducting an Integrative Literature Review section below. This guide was adapted from the Grove et al. textbook (pp. 455-469) and the PRISMA Checklist (2009).


To complete this assignment, you will need to review the Guide to Conducting an Integrative Literature Review section on the next page and the Integrative Literature Review Secondary Steps Template. You will complete the Secondary Steps 17 – 23, except the items that are omitted. Each part must be in current APA format and will be submitted through Turnitin.

You will submit the literature matrix as indicated below. See the chart below (on p. 2) for specific steps. For each section, you will need:

  • ILR-Secondary Steps Assignment (Steps 17-23, except where omitted):
    • Integrative Literature Review Secondary Step Template (Excel spreadsheet)
    • Include a minimum of 20 references on the Integrative Literature Review Secondary Step Template
    • Ensure the title of your project is entered in the top line
    • Review the rubrics for grading details.

Guide to Conducting an Integrative Literature Review

PRISMA 2009 Checklist

Section/topicStep#Checklist item
Title1Identify the report as a systematic review, meta-analysis, or both.
Structured summary  2Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number. Note: This step will be completed in Part 3 of the ILR
Rationale3Describe the rationale for the review in the context of what is already known.
Objectives4Provide an explicit statement of questions being addressed regarding participants, interventions, comparisons, outcomes, and study design (PICOS). Note: This step should clearly state the purpose of your ILR
Protocol and registration OMIT*5Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
Eligibility criteria6Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
Information sources7Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched. Recommend: EBSCO, CINAHL, MEDLINE, ProQuest, Sage, OVID
Search8Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
Study selection9State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
Data collection process OMIT*10Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
Data items11List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made. Note: This step asks you to identify and define (if needed) your key search terms
Risk of bias in individual studies12Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis. Note: In this step, briefly discuss what you would be looking for in articles that would make you question researcher bias.
Summary measures OMIT*13State the principal summary measures (e.g., risk ratio, difference in means).
Synthesis of results OMIT*14Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
Risk of bias across studies15Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies). Note: See Step 12
Additional analyses OMIT*16Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.
RESULTS (MATRIX) Note: Use the provided Integrative Literature Review Secondary Step Template and complete the following steps and requires data fields
Study selection17Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram. Note: A minimum of 20-25 articles must be screened and at least 15 selected for analysis and inclusion. Existing systematic literature reviews and all grey literature are excluded.
Study characteristics18For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
Risk of bias within studies19Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12).
Results of individual studies20For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot. Note: Focus on providing a succinct summary of key article findings
Synthesis of results OMIT*21Present results of each meta-analysis done, including confidence intervals and measures of consistency.
Risk of bias across studies22Present results of any assessment of risk of bias across studies (see Item 15). Note: Include any concerns of researcher bias
Additional analysis OMIT*23Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]).
Summary of evidence24Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers). Note: Based on the analysis of the studies you have reviewed, evaluate what similarities and differences exist.  Identify strengths and weaknesses of your Integrative Literature Review process and results.
Limitations25Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias). Note: Address threats to internal and external validity of your research methods
Conclusions26Provide a general interpretation of the results in the context of other evidence, and implications for future research. Note: Include the implications and relevancy of your findings to nursing practice.
Funding OMIT*27Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.

From:  Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic

Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097

*OMIT – This step is an observed/recommended practice of PRIMA; however, it is not a requirement for the completion of this assignment.

Level of Evidence Table

Level of Evidence Type of Study
IaEvidence from a systematic review of all relevant randomized controlled trials (RCTs), or evidence-based clinical practice guidelines based on systematic reviews of RCTs
bEvidence from a systematic review of all relevant non-RCTs, or evidence-based clinical practice guidelines based on systematic reviews of RCTs
IIaEvidence obtained from at least one well-designed RCT.
bEvidence obtained from at least one well-designed non- RCT
III Systematic review of correlational or observational studies
IV Single correlational or observational studies
V Evidence from systematic reviews of descriptive and qualitative studies
VI Evidence from a single descriptive or qualitative study
VII OMIT* Evidence from the opinion of authorities and/or reports of expert committees

Adapted from Melnyk B. M. & Fineout-Overholt E. (2005). Rating system for the hierarchy of evidence: Quantitative Questions. Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: Wolster-Kluwer.

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