Integrative reviews in Brazilian nursing postgraduation programs: a bibliometric study

Objectives: to analyze the Brazilian scientific integrative review production in postgraduation nursing programs. Methods: bibliometric design, carried out in the database of dissertations and theses of the Coordination for the Improvement of Higher Education Personnel, in October 2018. Results: 35 dissertations and 1 thesis were found. Most studies were carried out at the University of São Paulo; the main methodological reference was Mendes, Silveira and Galvão (2008); for data collection, it was Ursi (2005). The most used database was CINAHL, followed by LILACS and PubMed. The period of publication varied from 5 to 30 years; and the sample, from 6 to 299 texts. Some studies did not mention keywords, data collection period, exclusion criteria or publishing period. Conclusions: despite the growing popularity of integrative review studies, they are undervalued in the stricto sensu postgraduation program in nursing and there are shortcomings in the implementation of the method, related to the absence of important elements. Descriptors: Nursing; Review; Education, Graduate; Education, Graduate, Nursing; Bibliometrics. postgrado stricto sensu en enfermería y fragilidades en la ejecución del método, con ausencia de elementos importantes. Descriptores: Enfermería; Revisión; Educación Superior; Educación de Postgrado en Enfermería.


INTRODUCTION
Integrative reviews present, in an orderly manner, research results on a specific topic, with the aim of facilitating the use of scientific evidence in clinical practice. They started to be reported as a research method in 1980 (1) , but until 1998 there were no nursing studies using this methodology in Brazil (2) . In the first decade of the 2000s, pioneering studies began to emerge, with great repercussions in the nursing area (3) . It was also during this period that national productions emerged with information on the steps for conducting research using this methodology, offering theoretical support to researchers (1) .
Despite this growth, there are still difficulties in carrying out this type of study, mainly in differentiating it from systematic reviews and in the operationalization of its basic steps. Both have a delimited theme, start from a research question, and have a defined protocol to replicate the study and reduce bias. The particularity of the integrative review is that it includes studies with different methodological approaches, whether qualitative or quantitative, covering a broader range on the studied subject (4) .
This type of research reached lato sensu postgraduation courses, and even stricto sensu ones, since the number of courses and students requiring tutelage increased, the time to develop the study diminished, scientific production increased, and access was made easier through the internet. Integrative reviews are also to be predecessors to the production of primary studies, since they support the assessment of the current knowledge on the subject and help to clearly define the objects of studies. In many studies, at this category of formation, there is a chapter, session or even an article dedicated to the review phase (5) . Therefore, this research raises the following question: What is the current situation of scientific production in Brazilian postgraduation courses in nursing that use integrative reviews as a method?

OBJECTIVES
To analyze the Brazilian scientific integrative review production in postgraduation nursing programs.

Ethical aspects
The research was not submitted to the Human Research Ethics Committee since it was carried out with secondary and public domain data. However, the copyright preservation of the studies was considered.

Study design, period and location
This is a bibliometric study that, through mathematical techniques, evaluates the scientific production of several areas of knowledge. It considers databases, dissertations and theses, as they are able to provide information for building an overview of the theme (6) .
The data was collected at the Theses and Dissertations database of the Coordination for the Improvement of Higher Education Personnel (CAPES). These types of work were chosen because they comprise a high level of scientific production in the country, presenting methodological rigor and being validated in evaluation boards. Data were collected in October 2018.
In the search strategy, the controlled keyword "Review" was used, as established by the database Health Sciences Descriptors (DeCS). In order to refine the search, the keyword "Integrative" was added, despite not being a standardized term. As a resource, the expression in quotation marks and the database own filters were used, selecting "Nursing" as the area of knowledge.

Population or sample; inclusion and exclusion criteria
The inclusion criteria were theses or dissertations, available in full, which used the integrative review as their only research methodology. Completed and approved studies from 2013 were included, as did those that were available in full on the Portal up to 2017. Researches with other types of review or who did the integrative review to support an original research were excluded.

Study protocol
In the first stage, through the use of the expression "Integrative Review", 862 studies were found. After filtering by the field of knowledge (nursing) and year, 336 remained. The abstracts were read to identify if the main objective of the study was to carry out an integrative review and if they met the other inclusion and exclusion criteria. After selecting the studies, data was extracted and organized in a Microsoft Excel ® spreadsheet, containing the variables of interest.

Statistics and analysis of results
The information contained in the spreadsheet was analyzed individually, composing the study variables. Data was analyzed descriptively and presented in the form of tables and graphs, according to the specificity of each information.
of Integrative reviews in Brazilian nursing postgraduation programs: a bibliometric study Nobre TCN, Rosa DOS, Heliodoro EA.
The number of articles used in the reviews varied, with six being the smallest sample (34) , while the largest was 299 (13) . 27 different databases and sites were found in the studies, with a predominance of three: LILACS, mentioned by 86.1%; and PubMed and CINAHL, used by 63.8% of the studies.

DISCUSSION
In the results, among the 36 studies, there was only one thesis. The predominance of dissertations related to stricto sensu programs, within a specific subject, was also found in another bibliometric study, which found this to be true for 82% of dissertations found in the CAPES database on palliative care (43) . One possibility for this result is the fact that the master's courses were implemented first, and are in greater numbers among postgraduation programs, contributing annually to a vast scientific production (44) .
There was a diversity of study topics, including subjects such as the legalization of marijuana. However, most of these studies are focused on areas related to assistance to specific groups or conditions. This demonstrates consistency with the objective of an integrative review, which is to assist in decision making in clinical practice through the synthesis of available knowledge (1) .
The Universidade de São Paulo (USP) stood out in the number of works produced; its courses are between grades 6 and 7 in the CAPES assessment, and the institution is considered to be a leadership in the country due to its high standard. Similar results were found in a bibliometric study on the history of nursing, in a research in the CAPES database (45) . The fact that USP is a pioneer in offering postgraduation programs in the field of nursing, with a master's degree program since 1973 of Integrative reviews in Brazilian nursing postgraduation programs: a bibliometric study Nobre TCN, Rosa DOS, Heliodoro EA. and a PhD course since 1989, can explain its high production on varied themes (46) . Although Mendes, Silveira and Galvão (2008) were the authors most used for methodological support, it was possible to notice that there are other national and international references. This is observed in a national dissertation, considered reference on the theme, which compared five studies on the subject and developed an instrument for data analysis, mentioning the contribution of stricto sensu production to the integrative review study design (47) .
The number of databases and sites used is quite large: 27. However, there is a predominance of the LILACS database, which was used in 86.1% of the studies. The countries (Latin America) considered by the database, the language, the inclusion of its acronym in the DeCS list and studies published exclusively on LILACS may justify its dissemination among Brazilian researchers (48) .
Some aspects of the methodology were not mentioned in the studies, making its replicability impossible and, thus, demonstrating weaknesses in the construction of the study. It is essential to cite and explain the data collection period, descriptors, exclusion criteria and publishing period. Methodological rigor is an important aspect of primary research and of review studies. All types of researches require a standard of excellence to guarantee their validity and scientific credibility so that the result brings significant contributions to clinical practice (2)(3) .
There is a tendency to present the results in a table with a synthesis of the studies main information. This is a strategy that allows the reader to easily find study results and information. It is considered an important attribute, which facilitates communication using visual strategies to present information, enabling comparisons, identification of patterns, and divergences (3)(4) . However, as expected in the analysis of an integrative review, the quantitative data is not analyzed in-depth, and a greater emphasis is put on qualitative data and discursive analyses. This can lead to questions about its quality, since the subjective component does not allow clarity about studies inferences (2) .
There were no restrictions to the number of texts included in the review. 5 (14%) researches had a sample of less than 10 articles, and most had up to 20 (54%). Likewise, in the literature, there is no clarity on the number of articles that should be included in an integrative review; the recommendation is to use all that are found, regardless of how many (1) .
The data collection method proposed and applied by Ursi (2005) was used in 44.4% of the studies, being the most cited reference. An instrument for data extraction prevents relevant information from being lost during the review, minimizes errors in transcription, guarantees reliability, and indicates how the data will be analyzed, facilitating its execution (2,4) .
Even with these findings, integrative review studies are still in low numbers in master's and doctorate scientific production in nursing, varying from less than 1% to 13% of the publications, depending on the theme (43,49) . However, an obstacle against conducting an integrative review in stricto sensu programs is the difficulty in publishing the paper, considering the current requirements related to scientific publications (2) .
Thus, it was concluded that the integrative review is a methodology that can assist in the progress of science and in the construction of knowledge in master's and doctoral programs in nursing. It can synthesize researches findings, point out gaps, justify new studies, and avoid repeating content (1)(2) .

Study limitations
The selection of a single database can be considered a limitation for this study, as other dissertations and theses are in other databases, and thus were not identified/selected. However, the study considered the main database for indexed graduate studies in Brazil.

Contributions to the field of nursing, health, or public policy
The study brings, as a contribution to the field of nursing and health, information for the development of integrative review studies, providing the researcher with elements to be able to respect the rigors of the method and its execution.

CONCLUSIONS
Despite the popularity of integrative review studies, they are undervalued in the stricto sensu postgraduation programs in Brazil. Shortcomings in the execution of the method, such as the absence of elements that constitute its basic steps, compromise the rigor of the studies and the compliance with the demands of scientific research. This is an important research method for professional training and clinical practice in nursing, and can be applied at different levels of education, contributing to the scientific diffusion in Brazilian nursing.
Analyzing the application of integrative reviews in dissertations and theses allowed to characterize their production, pointing out possibilities for expansion, mainly in doctorate courses, which can use this methodology to develop new knowledge, not only with philosophical foundations, but also through the intertwining of scientific knowledge and practice.