Integration in mixed methods research (MMR): principles and practice in a study investigating assessment decisions of undergraduate nursing student competence.

The increasing proliferation of Mixed Methods Research (MMR) as an approach to nursing inquiry reflects a pragmatic ‘needs-based’ approach to explore complex social phenomena, which is capable of supporting a deeper understanding of the phenomenon of interest. Combining and interpreting data from the qualitative and quantitative research strands through processes of integration, draws upon the strengths of both paradigms and is considered a desirable outcome which enhances the value of MMR (Fetters et al 2013). However, selecting a MMR approach is not a natural or easy methodological choice, with the challenge of integrating qualitative and quantitative data in MMR subject to long-standing and extensive discourse. Epistemological concerns regarding the compatibility of paradigms, alongside discussion of integration strategies to develop meta-inferences (integrative findings from MMR), and whether data integration is the only possible outcome of MMR, shape the nature of the debate. Reviews of MMR studies reveal discrepancies between principles for integration and what happens in practice, with commentators noting that implementing integration is often limited, under-theorised and difficult to achieve (Fetters et al 2013, Kuckartz 2017, Uprichard & Dawney 2019). This paper critically explores integration principles and practice in MMR, supported with data drawn from a sequential embedded MM study investigating assessment decisions of undergraduate student competence in practice. With integration extending beyond any one individual method, and concerned with interaction, whether coherent or divergent, and synthesis of data across paradigms, this paper will present the stages of an integration strategy, and the underpinning integration principles. The product of integration, through ‘side by side’ integration displays (Kuckartz 2017) will also be outlined. The paper illustrates how findings from integrative synthesis and theorisation can provide impactful explanations for problems encountered in nursing practice and seeks to stimulate debate and methodological development regarding integration in MMR.