Comparative Analysis Methodologies in Nursing Research: A Scoping Review

ABSTRACT

Background

Being a global profession, having evolved differently across different geographical areas, and with increasing global migration, nursing is well positioned to undertake comparative research to facilitate understanding and identify areas for development. Despite this, little is known about comparative research use in nursing, and there is little guidance for researchers on how to approach it. With increasingly sophisticated approaches, there is a need to understand how comparative analysis is currently being used.

Objective

To review nursing research using comparative analysis as a methodology, specifically exploring approaches employed and topics examined.

Methods

A scoping review of published nursing research was conducted using Cumulative Index to Nursing and Allied Health Literature, Proquest Central, Medline, and Directory of Open Access Journals, with no defined time limits applied and where ‘comparative analysis’ appeared in the manuscript title. Findings are reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews.

Results

The search yielded 324 records from which 101 were included in the final review after titles and abstracts and subsequent full‐text screening. Analysis was conducted on included studies, involving chronological distribution, publication location, study design, geographical distribution, nature of comparisons, analytic approaches adopted, and methodologists identified. The earliest study was published in 1958, and a steady increase was noted over recent years. While a majority were conducted in the United States, these approaches were used across a large number of countries. Comparisons were made across an extensive array of topic areas, and the emergence of contemporary approaches such as fuzzy logic and qualitative comparative analysis was noted.

Conclusion

The increase in studies using comparative analysis indicates its applicability for addressing nursing research questions. With growth in sophisticated comparative analysis approaches, there is a need for nursing research courses to include relevant educational preparation for novice researchers.

1. Background

Nursing is a global profession; however, it has evolved differently across the world, meaning it differs across countries. The profession is influenced by local regulation, practices and cultures. Similarly, education to become registered as a nurse varies – nurses work in a vast array of different settings, roles and scopes of practice (World Health Organization 2020). Hence, there is vast potential to employ research approaches to enable comparisons across settings to inform nursing practice, policy and education.

Comparative analysis is manifested as a variety of approaches enabling comparisons and contrasts to be drawn across different datasets. At the most basic level, analysis employs descriptive statistical analysis or seeks to draw conclusions across case studies (Yin 2014). As an approach, it is not new, but over recent decades, sophisticated approaches to comparative analysis have evolved. Much of this evolutionary work was initiated by Charles Ragin (1987) through his foundational work, The Comparative Method. In conceptualising the comparative method, Ragin identified dilemmas in both quantitative and qualitative social research approaches, the first seeking to explore the complexity of social phenomena to make broad conclusions from patterns in data, while the latter making empirical generalisations that were difficult to explain. He saw “a deep complementary relationship between case‐oriented and variable‐oriented research” that augmented “their mutual dependence” (Ragin 1999, 106). Hence, he proposed a ‘middle ground’ drawing upon the two approaches to explore similarities and differences, using Boolean logic to case analysis rather than traditional statistical approaches, and seeking to uncover causal complexities (Ragin 1999). This was furthered by Drass and Ragin with the introduction of Qualitative Comparative Analysis (Ragin 1999). Marx et al. (2014) identified five key components to the method; it is case‐based, links configurations of causally relevant conditions to outcomes, allows iterative means of developing explanatory models, facilitates multiple causations and reduces empirical complexity of cases. Pickvance (2001) clarified that comparative analysis requires that data is gathered on two or more cases or units and that there must be an attempt to explain the comparison, not just describe it. These cases or units can be any type of variable but should be similar, though not necessarily identical. The comparative analysis is used to make sense of similarities or to explain differences between the cases/units.

Since Ragin's initial work, Qualitative Comparative Analysis has continued to develop with three key variants emerging: crisp set (csQCA), fuzzy‐set (fsQCA) and multi‐value (mvQCA). Crisp set was the first variant, seeking to “simplify, using Boolean logic, complex configurations, and to discover configuration models of multiple causal configurations” using a dichotomy of categorical conditions (Roig‐Tierno et al. 2017, 17). Multi‐value works similarly treat variables as being multi‐valued, rather than dichotomous. Fuzzy‐set is considered a more realistic approach and has been widely adopted in a range of disciplines, enabling “asymmetrical causal relationships” (Roig‐Tierno et al. 2017, 17) to be identified and provide rich findings.

Despite the potential value for research comparing nursing across different contexts to enable new understandings, there appears to be little research conducted aimed towards such activity. Working on a funded comparative analysis study ourselves, we found scant previous work to guide us. Hence, the aim of this review was to examine existing nursing research using comparative analysis as a methodology, specifically exploring approaches employed and topics examined.

2. Methods

A scoping review informed by Joanna Briggs Institute guidelines (Peters et al. 2020) was employed to search for studies reporting on comparative analysis research in nursing. This review type was chosen as the preferred approach as it enables mapping what is known in a particular field (Peters et al. 2020). The databases, Cumulative Index to Nursing and Allied Health Literature, Proquest Central, Medline and Directory of Open Access Journals, were searched for relevant studies with ‘comparative analysis’ and ‘nurs*’ in the title. No specific time period was used, enabling us to review all relevant studies published using comparative analysis. The database search was conducted in September 2023. Findings are reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (Tricco et al. 2018). The review was limited to studies published in the English language. No protocol was registered.

A total of 324 records from the search were uploaded into EndNote and then into Covidence for screening. Of these, 144 were duplicates that were removed, leaving 180 for title and abstract screening. This process excluded a further 49 records as irrelevant. Full‐text review was conducted on 131 records, for which a total of 30 were excluded for wrong design (n = 16), focus not on nursing (n = 2), full text not available (n = 11) and not in the English language (n = 1). The final review included 101 studies. Figure 1 presents the PRISMA flow chart of the process. Two reviewers independently reviewed at all stages, and conflicts were managed through discussion. As study quality was not relevant to this review, quality appraisal was not conducted.

FIGURE 1.

PRISMA flow diagram (Page et al. 2021).

Data were extracted using the extraction facility in Covidence. This included general study information, the nature of the comparative analysis approach described, any theorists related to comparative analysis identified, the nature of the comparison and the population being studied. General study details are presented in Table 1. Data were analysed using summative content analysis (Hsieh and Shannon 2005) enabling addressing the review aim.

TABLE 1.

Extracted study characteristics.

Author/year	Journal title or dissertation	Study location	Aim of study	Study design	CA approach described	Theorists identified	Nature of comparison	Population description	Total number of participants
Abdullah et al. (2022)	Jurnal Ilmu dan Teknologi Kesehatan	Indonesia	To analyse differences in nurses' cultural competence in inpatient, outpatient, and emergency rooms	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing work context	Nurses working in public hospital in Tapal Kuda region in East Java province	108 in total–41 inpatient, 32 outpatient, 35 emergency room
Abraham et al. (1995)	International Journal of Nursing Studies	United States	To compare conceptual foci and methodological characteristics of research projects which tested effects of nursing interventions, published in four general nursing research journals with predominantly North American, and two with predominantly European/International authorship and readership.	Cross‐sectional study	Quantitative comparative analysis	None	Across international nursing journals	10 volumes of 6 refereed nursing journals–4 North American and 2 European/International	2746 articles
Acero et al. (2023)	Healthcare	France	To identify, quantify, and compare all activities performed by nurse coordinators in oncology care settings from an organisational approach	Case study	Qualitative comparative analysis; Quantitative comparative analysis	None	Across nursing work context	NCs undertaking PPC roles for cancer patients at 4 French HCOs	14 coordinators
Ahmad and Oranye (2010)	Journal of Nursing Management	United Kingdom, Malaysia	To examine relationships between nurses empowerment, job satisfaction and organisational commitment in culturally and developmentally different societies	Cross‐sectional study	Quantitative comparative analysis	None	Across countries	Nurses in two teaching hospitals in Malaysia and England	556 in total—338 in Malaysia, 168 in England
Alcorn and Rennie (1980)	American Journal of Community Psychology	Canada	To identify types of helping responses given by professional helpers who are not part of the mental health guild of professionals	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing, social work, sales and teaching	RNs in 2 teaching hospitals, social workers in 6 teaching hospitals, teachers in 6 public high schools and salespeople	80 in total, 20 from each group
Alexopoulos et al. (2006)	International Archives of Occupational and Environmental Health	Netherlands, Greece	To analyse cross‐cultural differences between Greek and Dutch nursing personnel in association with risk factors and occurrence and consequences (absenteeism and medical care seeking) of musculoskeletal disorders	Cross‐sectional study	Quantitative comparative analysis	None	Across countries; Across nursing work context	Nurses in nursing homes in The Netherlands and in general hospitals in Greece	393 in The Netherlands, 351 in Greece
Allvin et al. (2011)	Journal of Biomedical Semantics	Finland, Sweden	To compare content and linguistic characteristics in Finnish and Swedish free‐text nursing narratives from intensive care units	Cross‐sectional study	Quantitative comparative analysis; Content analysis	None	Across countries	ICU inpatients for at least 5 days and at least 16 years of age	Qualitiative–3 health records from each country Quantitative–514 Finnish and 379 Swedish health records
Alshumrani et al. (2022)	Belitung Nursing Journal	Saudi Arabia	To determine level of professionalism among nurses and its differences according to socio‐demographic characteristics	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Nurses from Eastern, Northern, and Central regions of Saudi Arabia	320 in total
Araujo‐Hernández et al. (2022)	Foods	Spain	To identify dietary behaviours of nursing and engineering degree students at the University of Huelva during COVID‐19 confinement, in addition to identifying factors influencing these habits.	Mixed methods	Quantitative comparative analysis; Content analysis	None	Across nursing, computer science and engineering	Final year nursing, computer science and engineering students	Quantitative—139 students (85 nursing students) Qualitative—22 students (11 nursing students)
Bailey and Claus (1969)	Nursing Research	United States	To describe personality patterns of four classes of nursing students in sophomore year, compare personality patterns of students and compare University of California students with other nursing student groups	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing student groups	Four classes of nursing students at University of California	247 students
Bakertzis and Myloni (2021)	Health Services Management Research	Greece	To explore how doctors', nurses' and administrative staff work engagement in the Greek healthcare sector influences their job performance level in each profession.	Cross‐sectional study	Quantitative comparative analysis	None	Across health professions	Public health sector employees in Greece	85 doctors, 139 nurses, and 45 administrative staff
Balogh et al. (1998)	International Journal for Quality in Health Care	United Kingdom	To devise an analytical framework to help identify strengths and weaknesses in the audit process as specified by existing psychiatric nursing audit systems, in order to analyse current audit practice and identify improvements for incorporation in the Newcastle Clinical Audit Toolkit for Mental Health	Case study	Framework analysis	None	Across audit systems for mental health nursing	Mental health nursing audit systems in use in the UK	6 systems
Beil‐Hildebrand and Smith (2022)	Policy, Politics & Nursing Practice	United States, Canada, Germany, Austria, Switzerland	To compare professionalisation and educational standards of Advanced Practice Nursing with specific attention to geographical, political, and professional factors both current and historical, influencing evolution of these nurse leaders	Case study	Descriptive comparative design	None	Across countries	Literature, scientific articles, governmental regulatory texts, and legislative codes from each country from 1970 to 2022	NA
Bellaguarda et al. (2015)	Rev. Latino‐Am. Enfermagem	Canada; Brazil	To analyse differences between medication prescriptions by nurses in Brazil and Ontario, Canada	Case study	Not described	None	Across countries	Legal and professional organisation documentation	NA
Bellinger and Cleland (1969)	Nursing Research	United States	To compare nurses from two different racial backgrounds on selected variables that could influence their pattern of employment	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Nurses from two racial groups	540 Causasian, 36 coloured
Bhupathiraju et al. (2017)	American Journal of Epidemiology	United States	To compare results of hormone therapy for major health outcomes in the Nurses' Health Study and Women's Health Initiative among women in comparable age groups at HT initiation and among women using similar formulations of HT	Cohort study	Quantitative comparative analysis	None	Across nurses and other women	Women who were post‐menopausal and had reached the age of 50 years	Unclear
Bigbee et al. (1992)	American Journal of Public Health	United States	To assess attitudes of Wyoming physicians, pharmacists, nurses, and nurse practitioners about granting prescriptive authority to nurse practitioners.	Cross‐sectional study	Quantitative comparative analysis	None	Across health professions	4 groups of health professionals	436 pharmacists, 684 physicians, 59 nurses, 40 nurse pracititioners
Bitsika et al. (2014)	Nurse Education Today	Greece	To explore skill acquisition and retention by using 2‐stage method compared to 4‐stage method for venous cannulation training of nursing students	Non‐randomised experimental study	Quantitative comparative analysis	None	Across educational interventions	Nursing students	Group A–54 students, group B–50 students
Bloom et al. (1980)	HCM Review	United States	To compare perceptions of key issues for striking during collective bargaining	Cohort study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Public health nurses and managers	Quantitative–85 nurses comprising 45 strikers, 40 non‐strikers and 10 managers Qualitative–10 managers comprising Director of Nursing, 3 Assistant Directors, Director of Public Health and county managers
Borowiak et al. (2015)	Clinical Interventions in Ageing	Poland	To compare expectations of older people from urban, rural, and institutional environments concerning nursing care with respect to care provided and elements of a comprehensive geriatric assessment.	Cross‐sectional study	Quantitative comparative analysis	None	Across urban, regional, rural settings	Older people living in urban, rural areas and nursing homes	2627 older people
Bryant (2001)	Journal of Law and Medicine	Australia	To compare nursing regulation across Australian states and territories	Case study	Framework analysis	None	Across Australian states and territories	Documents	NA
Choflet et al. (2021)	Journal of Clinical Nursing	United States	To describe substance use and mental health characteristics of nurses who complete suicide compared to the general population who complete suicide	Cross‐sectional study	Quantitative comparative analysis	None	Across nurses and general population	Suicide data retrospectively analysed in the Centers for Disease Control and Prevention National Violent Death Reporting System from 2003 to 2017	2306 nurses and 185,620 non‐nurses
Clem et al. (2021)	Revista Online de Pesquisa	Brazil	To analyse performance of students who submitted to training on the role of nurses in the blood therapy process, in comparison with those who did not receive training.	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing student groups	Students with and without training	37 in total–15 trained, 22 untrained
Commendador and Chi (2013)	Journal of Interactive Learning Research	United States	To understand the nature of nursing students' perspectives towards simulative learning modality for gaining pre‐clinical experience via self‐paced cognitive tool–Avatar.	Cross‐sectional study	Quantitative comparative analysis	None	Across students	Nursing students enrolled in Paediatric Nursing class	22 females and 7 males
Cramer et al. (2006)	Policy, Politics & Nursing Practice	United States	To determine trends in RN shortages between urban and rural areas	Cross‐sectional study	Quantitative comparative analysis	None	Across urban, regional, rural settings	Counties in the state of Nebraska	66 counties
DeChow et al. (1968)	JAMA	United States	To compare education for diploma, associate degree and bachelor programs	General descriptive study	Descriptive comparative design	None	Across education programs	NA	NA
Deliyanni (1993)	Dissertation	United States	To explore differences and similarities between baccalaureate educational programs for nurses and physician assistants	Exploratory descriptive study	Content analysis	None	Across education programs; Across education institutions	Colleges and universities in the US offering both nursing and physician assistant programs	20 higher education institutions
Delmas et al. (2020)	Nursing Open	Switzerland	To examine and compare quality of caring attitudes and behaviours as perceived by haemodialysis patients and their nurses	Cross‐sectional study	Descriptive comparative design	None	Across nurses and patients	Haemodialysis patients and nurses in 10 haemodialysis units	140 patients and 101 nurses
Devi et al. (2010)	International Journal of Nursing Education	India	To compare outcomes of two teaching learning modules in terms of UG students' competency in drug administration, and determine influence of students' competence in drug administration on patients' understanding of drug therapy	Non‐randomised experimental study	Quantitative comparative analysis	None	Across educational interventions	Second year nursing students	167 in total, 80 control and 87 experimental
Dobratz et al. (2012)	Journal of Professional Nursing	United States	To examine how Master of Nursing students develop competence in scholarly inquiry	Cohort study	Descriptive comparative design	None	Across postgraduate students	Scholarly projects from 1996 to 2009	230–112 from 1996 to 2003 and 118 from 2004 to 2009
Dobrowolska et al. (2016)	Nurse Education Today	United States, Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain	To describe and compare the clinical mentor's role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education	Case study	Descriptive comparative design	None	Across countries	Nurse educators working in HEI/University institutions who were members of the UDINE‐C international network	13 educators
Donnelly and Wiechula (2013)	Nurse Researcher	Australia	To describe an example of qualitative comparative analysis (QCA) in a study about the role of clinical placement, nursing education and patient outcome	Case study	Qualitative comparative analysis	Donnelly, Ragin, Vink, Van Vliet, Schneider, Wagemann, Rihoux, Wiechula	Across recently graduated registered nurses	Recently graduated registered nurses	16 nurses
Englert (2009)	Dissertation	United States	To examine relationship between selected variables and performance on the National Council Licensure Examination for Registered Nurses (NCLEX‐RN)	Retrospective comparative design	Quantitative comparative analysis	None	Across student groups	Graduates of a baccalaureate program	120 graduates
Esposito (1993)	Dissertation	United States	To determine extent to which accommodations have been made for the non‐traditional student in basic programs of nursing in the United States.	Exploratory descriptive	Descriptive comparative design	None	Across education programs	All diploma, associate degree and baccalaureate nursing programs accredited by National League For Nursing in the USA in 1991–1992	40 diploma, 40 associate diploma and 32 baccalaureate programs
Fernández‐García et al. (2021)	Nurse Education Today	Spain	To analyse influence of socio‐demographic variables of clinical educators and nursing students on satisfaction with clinical practice.	Cross‐sectional study	Fuzzy‐set qualitative comparative analysis (fsQCA)	Ragin, Eng, Woodside	Across students	Nursing students undertaking clinical practice and clinical educators	527 students and 187 clinical educators
Forsyth and McKenzie (2006)	Journal of Advanced Nursing	Australia	To evaluate and increase understanding of contemporary Registered Nurses' discontents, and compare these and their effects with those of nurses 20 years ago	Qualitative research	Qualitative comparative analysis	None	Across time periods	Registered Nurses	146 nurses
Genova (2014)	Dissertation	United States	To replicate a 1996 study comparing outcomes of attitudes and knowledge regarding pain survey of a convenience sample of medical‐surgical nurses in 2013 with nurses from 1996 to determine if attitudes towards pain had changed	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Nurses from inpatient, medical‐surgical units at a large multi‐facility health care system	58 nurses
Giménez‐Espert and Prado‐Gascó (2018)	Journal of Clinical Nursing	Spain	To explore empathy and emotional intelligence as a predictor of nurses' attitudes towards communication while comparing contribution of emotional aspects and attitudinal elements on potential behaviour	Cross‐sectional study	Fuzzy‐set qualitative comparative analysis (fsQCA); Regression modelling	Ragin, Eng, Woodside, Blackman, Wistow, Byrne	Across nurses generally	Nurses from 6 hospitals in Valencia	460 nurses
Gniewek et al. (2023)	Sustainability	Poland	To examine the occupational burnout and coping strategies among nurses working in different hospital settings.	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing work context	Nurses working in non‐invasive, intensive care and surgical units	1103 nurses
Guevara and Mendias (2002)	Pan American Journal of Public Health	United States, Argentina, Brazil, Colombia, Mexico	To identify changes in nursing practice and nursing‐practice environment that have occurred with implementation of health sector reform in five countries in the Americas.	Qualitative research	Qualitative comparative analysis	None	Across countries	Practising professional nurses	125 in total; 20 from Argentina, 42 from Brazil, 10 from Colombia, 36 from Mexico, and 17 from USA
Gunawan et al. (2020)	Policy, Politics & Nursing Practice	Indonesia	To explore differences in managerial competence of first‐line nurse managers	Cross‐sectional study	Quantitative comparative analysis	None	Across health organisations	Nurse managers from 13 hospitals	233 managers
Halcomb et al. (2014)	BMC Family Practice	Australia	To describe demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time.	Cross‐sectional study	Quantitative comparative analysis	None	Across time periods	Nurses working in general practice	Survey 1 (2003–2004) n = 294, survey 2 (2009–2010) n = 235
Hämel and Vössing (2017)	Primary Health Care Research & Development	Slovenia, Spain	To explore concepts and practices of GP‐nurse collaborations in primary health centres in Slovenia and Spain	Qualitative research	Content analysis	None	Across health professions	GPs and nurses	Unclear
Heslop and Plummer (2012)	Nursing Economic$	Australia, New Zealand	To compare two nurse staff allocation practice using cost modelling and analysis	Case study	Quantitative comparative analysis	None	Across countries	Retrospective data obtained from a cohort of electronic nursing workload management reports from hospital information systems	100 Australian and 14 New Zealand hospitals
Issel et al. (2016)	Journal of Public Health Management Practice	United States	To describe the extent to which hourly wages of RNs working in local health departments were competitive with hospital RN wages within the same county market.	Repeated measures	Quantitative comparative analysis	None	Across counties	Counties	12 departments
Jeffery et al. (2020)	International Journal of Nursing Education Scholarship	United States, Canada, Australia, Finland, Netherlands	To explore NP program curricula and admission criteria from six countries at varying stages of NP integration, and to provide insight into nuances of NP education within and between countries	Case study	Descriptive comparative design	None	Across countries	nurse practitioner education programs' websites	24 programs
Jessup (2013)	Dissertation	United States	To formulate in depth understanding of politics, personalities and processes that defined the midwife Medicare reimbursement effort, and explore how and why the process differed from the six year nurse practitioner Medicare reimbursement effort that culminated in 85% payment.	Case study	Qualitative comparative analysis	None	Across health professions	Midwives and nurse practitioners	14 midwives, 10 nurse practitioners
Kaasalainen et al. (2011)	International Journal of Palliative Nursing	Canada	To examine differences between rural and urban community nurses' delivery of palliative care services	Cross‐sectional study	Quantitative comparative analysis	None	Across urban, regional, rural settings	community nurses	277 nurses
Kalisch and Kalisch (1986)	Journal of Advanced Nursing	United States	To analyse differences in portrayals of nurse and physician characters in three major forms of entertainment media, novels, motion pictures and prime time television	Cross‐sectional study	Content analysis	None	Across health professions	nurse and physician characters from 1920 to 1980	670 nurse and 466 physician
Kennedy et al. (2015)	Journal of Advanced Nursing	Ireland	To review, discuss and compare nursing and midwifery regulatory and professional bodies' scope of practice and associated decision‐making frameworks	Case study	Content analysis	None	Across countries	Professional documentation	12 frameworks
Kim (1994)	Dissertation	United States	To examine from a supply perspective, Registered Nurses working in long‐term and acute care facilities.	Cross‐sectional study	Quantitative comparative analysis	None	Across time periods	national nursing surveys from 1984 and 1988	2
Kim et al. (2021)	International Journal of Environmental Research and Public Health	South Korea	To examine awareness and status of cancer patients and healthcare providers (physicians, nurses and social workers) regarding community linkage	Cross‐sectional study	Quantitative comparative analysis	None	Across health providers and patients	Oncology physicians, nurses, social workers, cancer patients	210 physicians, 200 nurses, 313 social workers, 308 patients
Kim et al. (2022)	BMC Nursing	South Korea	To identify problems in working environments for registered nurses (RNs), nurse aides (NAs), and caregivers using the 5th Korean Working Conditions Survey (KWCS)	Cross‐sectional study	Quantitative comparative analysis	None	Across caregiver groups	Registered Nurses, nurse aides, caregivers	484 RNs, 201 NAs, 505 caregivers
Kitson (2003)	International Journal of Nursing Studies	None	To outline the extent to which concepts of caring and nursing had been explored, and compare lay and professional caring roles.	Qualitative research	Framework analysis	None	Across caring roles	2 case studies from previous research on hospitalised elderly.
Koduah et al. (2021)	Healthcare	Hong Kong	To examine health literacy knowledge of students and practising nurses in Ghana and identify factors associated with that knowledge.	Cross‐sectional study	Quantitative comparative analysis	None	Across students and qualified nurses	Nursing students and practising nurses	477 students and 399 nurses
Kreitzer et al. (2002)	Alternative Therapies	United States	To explore attitudes of faculty and staff towards CAM in medicine, nursing and pharmacy in an academic health centre	Cross‐sectional study	Quantitative comparative analysis	None	Across health professions	Faculty and students at University of Minnesota	145 faculty, 228 students
Lehrer et al. (1991)	Journal of Human Resources	United States	To compare careers for RNs from three types of educational backgrounds	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Registered nurses holding Illinois licence	68,792
Liang et al. (2022)	International Journal of Mental Health Nursing	China	To explore the combination of different conditional variables leading to depressive symptoms among frontline nurses who fought against COVID‐19 during the outbreak in Wuhan City, Hubei Province of China.	Cross‐sectional study	Fuzzy‐set qualitative comparative analysis (fsQCA)	Ragin, Woodside	Across different groups of qualified nurses	Frontline clinical nurses	331
Long (1988)	Dissertation	United States	To determine commonalities and differences in nursing course objectives of accredited associate and baccalaureate degree nursing programs	Qualitative research	Qualitative comparative analysis	None	Across education programs	Course objectives from associate and baccalaureate degree programs	40 associate and 35 baccalaureate degrees
Lotta et al. (2021)	Journal of Comparative Policy Analysis: Research and Practice	Brazil	To analyse how the Brazilian government regulated the reorganisation of Primary Health Care (PHC) and how frontline workers responded to these initiatives, comparing roles played by nurses and community health workers	Cross‐sectional study	Content analysis	None	Across health professions	community health workers	100 Facebook posts with more than 700 interactions
Luta et al. (2022)	Cancers	Switzerland	To retrospectively analyse routinely collected data to describe implementation of nurse‐led interventions and evolution of the M.D. Anderson Symptom Inventory scores as patient‐reported outcome measures (PROMs).	Case study	Quantitative comparative analysis	None	Across nurse‐led consultation and routine care	Patients receiving routine care and nurse‐led consultation	75 routine and 66 nurse‐led
Malale et al. (2016)	International Journal of Nursing Education	Tanzania	To compare academic performance of diploma nursing students of public, private and faith‐based schools	Cross‐sectional study	Quantitative comparative analysis	None	Across education programs	Preservice nursing students	183 public, 51 private and 919 faith‐based school nursing students
Maughan (2006)	Dissertation	United States	To (a) determine if/how state laws mandating school nurses or school health services/activities influence state school nurse ratios and (b) identify other social, political, and cultural factors that influence school nurse‐to‐student ratios	Mixed methods	Qualitative comparative analysis; Quantitative comparative analysis; Content analysis	Ragin, Griffin, Mayer, Drass	Across states	Data from 50 US states and District of Columbia	30 interviews
McGillis Hall et al. (2019)	Journal of Nursing Management	United States, Canada	To examine performance differences among different writers of the National Council Licensure Examination‚ Registered Nurse (NCLEX‚RN) examination in Canada; to compare Canadian and US writer pass rate data; and identify if changes in Canadian nursing workforce could be related to introduction of NCLEX‚RN	Cross‐sectional study	Quantitative comparative analysis	Sasaki, Pickvance	Across countries; Across time periods	NCLEX‐RN examination outcomes in 2015, 2016, 2017	2015–157,975 US and 9074 Canada 2016–157,204 US and 9338 Canada 2017–157,720 US and 9659 Canada
McKenna et al. (2023)	Nurse Education Today	Australia; Indonesia	To compare postgraduate nurse education in Indonesia and Australia	Case study	Qualitative comparative analysis	Ragin	Across countries; Across education programs	Literature review and semi‐structure interviews	65 participated in interviews undisclosed number of literature reviewed
Melvin (1988)	Journal of Professional Nursing	United States	To analyse instructional costs of three baccalaureate nursing programs in one state university system	Case study	Economic comparison	None	Across education programs	Baccalaureate nursing programs in one state university system	3 programs
Merrill et al. (1998)	Psychological Reports	United States	To explore attitudes of physicians, nursing and medical students towards caring for patients with terminal illnesses	Cross‐sectional study	Quantitative comparative analysis	None	Across health professions	Medical students, doctors, student nurses	153 first‐year and 463 fourth‐year medical students, 55 doctors, 47 student nures
Michael et al. (2012)	Australian College of Operating Room Nurses Journal	Australia	To compare ACORN baseline outcomes data against reviewed research studies published in two major international perioperative nursing journals	Review	Content analysis	None	Across nursing journals	Research publications in three international perioperative nursing journals from 2006 to 2011	61 articles
Mimura et al. (2009)	Stress and Health	United Kingdom, Japan	To explore the relationship between work‐related stress, self‐esteem and childhood acceptance among candidates from nursing and pharmacy	Case study	Quantitative comparative analysis	None	Across countries; Across health professions	Nursing and pharmacy students in London and Tokyo	131 nursing and 91 pharmacy students in London, 344 nursing and 979 in pharmacy in Tokyo
Morales‐Mann (1989)	Journal of Advanced Nursing	Canada	To compare and analyse perceptions of nurses and patients about the importance or value of nursing activities in a postpartum unit	Cross‐sectional study	Quantitative comparative analysis	None	Across nurses and patients	Nurses and patients	25 nurses, 50 patients
Moreno‐Lacelle (2019)	Belitung Nursing Journal	Australia, Philippines	To compare and contrast nurse competency and performance indicators between the Philippines and Australia nursing competency systems	Case study	Qualitative comparative analysis	Donnelly & Weichula; Ragin, Zaret, Achen, Vink & Van Vliet	Across countries	Core competency standards	2 countries
Mtshali and Khanyile (2001)	Curationis	South Africa	To establish whether the Comprehensive Basic Nursing Course (CBNC) was able to develop students ethically, and how educational preparation from two different programmes (basic degree and basic diploma) influenced their ethical development.	Cross‐sectional study	Descriptive comparative design	None	Across education programs	Third and fourth‐year students from degree and diploma programs	40 diploma, 41 degree
Mulcahy et al. (2022)	Public Health Nursing	Ireland, Norway	To compare public health nurses' educational training in Ireland and Norway through a collaborative process	Case study	Descriptive comparative design; Content analysis	None	Across countries	Strategic, curriculum and operational documents at national and higher education institution level	Not stated
Nacos‐Burds (2010)	Dissertation	United States	To determine the predictive relationship between demographic and academic variables and NCLEX‐RN success; and if there were significant differences between urban and rural nursing students accounting for an increased percentage of rural NCLEX‐RN failures.	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Graduates from an associate degree nursing program in the Midwest	398
Navran and Stauffacher (1958)	Nursing Research	United States	To compare the personality structure of psychiatric and nonpsychiatric nurses	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Nurses working at four veterans administration general medical and surgical hospitals in the Pacific Northwest	167 medical‐surgical nurses, 196 neuropsychiatric nurses
Ölcer et al. (2021)	BMC Health Services Research	Germany	To explore how health care facilities used websites to inform (potential) health care users about changes in regulations, new protective measures implemented and about recommendations in context of the COVID‐19 pandemic	Qualitative research	Content analysis	None	Across health facilities	Websites of nursing, palliative and hospice care facilities	138
Palese et al. 2021	Journal of Clinical Nursing	Italy	To establish whether, and to what extent, validated tools measuring Unfinished Nursing Care (UNC) have the ability to detect discrete elements of the Integration of care‚ dimension of The Fundamentals of Care Framework (The Framework)	Cross‐sectional study	Framework analysis	None	Across tools identified in research publications	Tool validation studies	17 studies
Pan et al. (1997)	The Nurse Practitioner	United States	To compare similarities and differences between primary care nurse practitioners and physician assistants	Cross‐sectional study	Quantitative comparative analysis	None	Across health professions	Nurse practitioner and physician assistants	1091 nurse practitioners, 667 physician assistants
Papantoniou (2022)	Journal of Nursing Management	Greece	To compare frequency of sexual harassment among male and female nurses in Greece and capture the reasons for not reporting sexual harassment.	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Nurses working in the Greek NHS	1264 female and 507 male nurses
Pillay (2009)	Human Resources for Health	South Africa	To compare and contrast work satisfaction of nurses in public and private sectors	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Professional nurses	569
Pittman et al. (2021)	Medical Care Research and Review	United States	To explore how much and why nurse practitioner and physician assistant productivity varies across communit health centres.	Case study	Qualitative comparative analysis; Content analysis	Ragin, Rihoux, Thiem, Dusa	Across health professions	Community health centres	60
Pullen (1991)	Dissertation	United States	To compare Registered Nurse (RN) current and future demand between Tennessee rural and urban licensed hospitals and nursing homes.	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses; Across urban, regional, rural settings; Across health organisations	Urban and rural hospitals, urban and rural nursing homes	85 urban hospitals, 69 rural hospitals, 112 urban nursing homes, 96 rural nursing homes
Raffenaud et al. (2020)	Nursing Outlook	United States	To compare work family conflict (WFC) and family work conflict (FWC) among staff, managerial, and executive nurses.	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	RNs in the state of Florida in 2017	357
Rajan (2015)	i‐manager's Journal on Management	Malawi	To identify and differentiate perceptions of nurses working in multi‐speciality hospitals and single‐speciality hospitals towards push and pull factors of employee turnover.	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Nurses across multi and single specialty hospitals	60 from each hospital type
Reyes et al. (2013)	ISRN Nursing	United States	To determine if the nursing curriculum at a public university offered enough education and experience for graduating nurses to care for a diverse population by comparing perceptions of cultural competence with beginning sophomore nursing students' perceptions	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing student groups	Beginning and graduating nursing students at one university	46 beginning and 53 graduating students
Simandl (1990)	Dissertation	United States	To explore practising nurses' and nurse researchers' modes of knowing and beliefs regarding the phenomena of nursing in an effort to discern congruities and incongruities between the two groups of nurses' views.	Qualitative research	Qualitative comparative analysis	None	Across different groups of qualified nurses	Practising nurses and research nurses from Midwestern metropolitan areas	20 practising and 20 research nurses
Spicer (1993)	Dissertation	United Kingdom	To explore the focus of district nursing practice in order to identify areas of study for inclusion in the district nurse curriculum	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing work context	Patients in hospitals and community settings in one outer London Health Authority	100
Stenhouse et al. (2016)	Nurse Education Today	United Kingdom	To examine impact of previous caring experience, emotional intelligence and social connection scores on performance and retention in a cohort of first‐year nursing and midwifery students in Scotland.	Non‐randomised experimental study	Quantitative comparative analysis	None	Across nursing and midwifery student groups	Single cohort of students from adult and mental health nursing, and midwifery programs at a Scottish University	598
Stewart and Cox‐Davenport (2015)	Pain Management Nursing	United States	To compare perceptions of prelicensed nursing students and registered nurses towards nonpharmacologic methods of pain management.	Cross‐sectional study	Quantitative comparative analysis	None	Across students and qualified nurses	RNs and nursing students	49 RNs and 64 students
Stifter et al. (2015)	Nursing Research	United States	To examine association of nurse continuity with the prevention of hospital‐acquired pressure ulcers (HAPU)	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing work context	Episodes of care documented by nurses	42,403 episodes of care from 787 nurses
Taneva, Kirkova‐Bogdanova, et al. (2023)	Folia Medica	Bulgaria	To evaluate nursing students' knowledge of risk factors leading to unwanted pregnancies in nursing students between 2009 and 2019 and conduct a comparative analysis of nursing students' knowledge of abortion and its consequences over a ten‐year period	Cross‐sectional study	Quantitative comparative analysis	None	Across nursing student groups	Nursing students from one institution in 2009 and 2010	219 students in 2009, 210 in 2019
Taneva, Paskaleva, and Gyurova‐Kancheva (2023)	Iranian Journal of Public Health	Bulgaria, Germany, Denmark, Estonia, Ireland, Spain, Italy, Cyprus, Latvia, Portugal, Russia, North Macedonia, Slovenia, Finland, France, Czech Republic, Switzerland, Sweden	To investigate similarities and differences in training programs of nurses in selected EHEA member countries.	Case study	Qualitative comparative analysis; Content analysis	None	Across countries; Across education programs	Research articles, internet databases, emails to nursing education institutions.	19 countries; 13 articles, 56 documents from internet, 23 emails
Tellez (2012)	Nursing Economic$	United States	To evaluate the effect of nurse‐to‐patient ratios law on nurse job satisfaction and compare California nurses who were satisfied against those who were not	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses, Across years	Nurses registered with California Board of Registered Nursing from 1997, 2004, 2006, 2008	28,168
Waigandt and Chang (1989)	Evaluation & the Health Professions	United States	To compare pharmacology training of nurse practitioner programs with medical and dental schools	Case study	Quantitative comparative analysis	None	Across health professions; Across education programs	Schools with nurse practitioner, medical, dental programs	40 NP, 19 medical and 14 pharmacy schools
Wells (1990)	Dissertation	United States	To examine work controls of nurses and teachers and determine what motivates them to do what they do	Multiple methods	Descriptive comparative design	None	Across nurses and teachers	Nurses across one large major hospital and teachers across one large school district in Kansas	unclear
Wilson and Retsas (1997)	International Journal of Nursing Studies	Australia	To compare personal constructs that three groups of nurses (critical care nurses, gerontology nurses and general nurses) used to characterise effective nursing within their areas of practice.	Cross‐sectional study	Descriptive comparative design, Framework analysis	None	Across different groups of qualified nurses	RNs	100 in total, 60 gerontology, 26 critical care, 14 others
Xu and Kwak (2007)	International Nursing Review	United States	To compare characteristics of internationally educated nurses (IENs) and US‐educated nurses in the USA and examine trends and implications	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses; Across time periods	Internationally educated nurses and US‐educated nurses in the USA	Unclear
Yang et al. (2023)	Preventive Medicine	China	To explore the application of a new type of nanofiber membrane in blood purification of critically ill patients and compare and analyse its nursing methods	Randomised controlled trial	Quantitative comparative analysis	None	Across nurse‐informed and traditional care	People with chronic kidney failure on dialysis	80
Yosep et al. (2021)	Belitung Nursing Journal	Indonesia	To compare the working alliance of mental health nurses according to socio‐demographic characteristics	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Psychiatric nurses from West Java Province	120
Zhang et al. (2023)	Frontiers in Public Health	China	To assess how various factors (socio‐demographic variables, anxiety, transition shock, professionalism, teamwork situation, and daily work hours) influenced nurses' fatigue	Cross‐sectional study	fsQCA; Quantitative comparative analysis; Regression Analysis	Ragin	Across nursing specialty	Nurses who supported anti‐epidemic work in China	270
Zuriguel‐Pérez et al. (2018)	Journal of Nursing Management	Spain	To analyse levels of critical thinking among nurse managers and registered nurses and explore associations between these levels and socio‐demographic and occupational factors	Cross‐sectional study	Quantitative comparative analysis	None	Across different groups of qualified nurses	Nurse managers and RNs	44 managers and 295 nurses

3. Results

In total, 101 studies were included in the review. Published studies in nursing using comparative analysis were found to date back as far as 1958, with a generally steady stream of publications continuing through the subsequent decades. An increase in volume was noted over recent years, particularly since 2012 (Figure 2) indicating growing interest in these methodologies.

FIGURE 2.

Distribution of publications by year.

Tables 1 and 2 present the general characteristics of included studies. Around half (n = 49; 50.5%) were published in nursing journals, with the remaining in non‐nursing journals (n = 35; 36.1%) and as dissertations (n = 13; 13.4%). The predominant study designs were cross‐sectional (n = 57; 58.8%) and case study (n = 18; 18.6%) amidst a vast range of other designs. The majority of studies were conducted in the United States (n = 44; 45.4%) followed by nine in Australia, Canada and Spain, each with seven and six in the United Kingdom. Notably, beyond these, there were a further 39 countries represented, indicating that comparative analysis research in nursing is widely utilised (Table 2).

TABLE 2.

General study characteristics (N = 101).

Characteristic	n	%
Publication type
Nursing journal	49	50.5
Non‐nursing journal	35	36.1
Dissertation	13	13.4
Study design
Cross‐sectional	57	58.8
Case study	18	18.6
Qualitative	7	7.2
Exploratory descriptive	3	3.1
Cohort	3	3.1
Non‐randomised experimental	3	3.1
Mixed methods	2	2.1
Multi‐methods	1	1.0
Retrospective	1	1.0
Repeated measures	1	1.0
Review	1	1.0
Countries where conducted
United States	44	45.4
Australia	9	9.3
Canada	7	7.2
Spain	7	7.2
United Kingdom	6	6.1
Brazil, Greece, Indonesia, Ireland	4 each	4.1 each
China, Finland, Germany, Italy, Poland, Slovenia, Switzerland	3 each	3.1 each
Bulgaria, Czech Republic, France, Netherlands, South Africa, South Korea, Netherlands, Sweden	2 each	2.1 each
Argentina, Austria, Colombia, Croatia, Cyprus, Denmark, Estonia, Hong Kong, Iceland, India, Japan, Latvia, Malawi, Malaysia, Mexico, New Zealand, North Macedonia, Norway, Philippines, Portugal, Russia, Saudi Arabia, Serbia, Tanzania	1 each	1.0 each

Analysis of the application of comparative analysis identified a vast array of what was compared across the studies (Table 3). Most commonly, comparative analysis was used to compare different groups of qualified nurses (n = 21; 20.8%), compare aspects of nurses/nursing across countries (n = 16; 15.8%) and compare health/caring professions including nurses (n = 14; 13.9%). Most studies employed simple quantitative comparisons (n = 63; 64.9%), with a further 11 (11.3%) using descriptive comparisons using statistical approaches. Ten (10.3%) employed qualitative comparison, and three used fsQCA.

TABLE 3.

Comparative analysis characteristics (N = 101).

Characteristic	n	%
Nature of comparison
Across different groups of qualified nurses	21	20.8
Across countries	16	15.8
Across health/caring professions	14	13.9
Across nursing education programs/institutions	11	10.9
Across student groups	9	8.9
Across nursing work contexts	6	5.9
Across time periods	6	5.9
Across urban, regional, rural settings	4	3.9
Across health organisations/systems	4	3.9
Across states/counties	3	3.0
Across nursing and non‐health professions	3	3.0
Across nurses and patients	3	3.0
Across nursing journals	3	3.0
Across nurse‐led and traditional care	2	2.0
Across education interventions	2	2.0
Across students and qualified nurses	2	2.0
Across nurses and other women	1	1.0
Across nurses and general population	1	1.0
Analysis approach applied
Quantitative comparison	63	64.9
Content analysis	12	12.4
Descriptive comparative	11	11.3
Qualitative comparison	10	10.3
Framework analysis	5	5.2
Fuzzy set	3	3.1
Economic	1	1.0
Not described	1	1.0
Comparative analysis authors/methodologists drawn upon
None	91	90.1
Ragin	9	8.9
Woodside	3	3.0
Donnelly, Weichula, Eng, Rihoux, Vink, Van Vliet	2 each	2.0
Achen, Blackman, Byrne, Drass, Dusa, Griffin, Mayer, Pickvance, Saaki, Schneider, Thiem, Wagemann, Wistow, Zaret	1 each	1.0 each

Regarding employing work of comparative analysis authors or methodologists, 91 (90.1%) studies did not describe any theoretical approaches, while nine (8.9%) recognised Ragin's work, with a spread of other authors appearing only once or twice. Of those citing Ragin's work, one was from 2006, another from 2013, and the remainder were published since 2018, indicating its growing application in nursing.

4. Discussion

This scoping review sought to explore the extent to which comparative analysis has been used in nursing research and the types of topics examined. The review findings indicate that, as a methodology, comparative analysis has been used in nursing research for many decades. Recently, nurse researchers have also begun to utilise complex approaches, such as fuzzy‐set logic comparative analysis, and these approaches have been used in a variety of ways to answer varied nursing questions. The scope of studies included in our review suggests that there are diverse opportunities for its application, and the diversity of countries and continents represented indicates that nurse researchers are beginning to embrace comparative analysis to answer complex nursing questions.

Nursing is increasingly global and complex, with an expanding scope of practice and speciality practice areas emerging across many countries (World Health Organization 2020). In this review, the highest‐ranking type of comparison involved comparing across different types of nurses, indicating that comparative analysis can contribute to knowledge in this area. Mixed with this is the increasing international migration of health professionals, particularly nurses and midwives, into different health care systems, where migration, registration, and work adaptation can be particularly challenging (Safari et al. 2022). Comparative analysis of nursing education programs/curricula could facilitate making sense of similarities and explaining differences in the preparation for practising nursing. Having improved explanations may assist in the recognition of the different curricula and may assist in improving/streamlining processes leading to professional licensure as nurses in other countries. In providing approaches to comparing across health, education, and nursing systems, comparative analysis research approaches offer opportunities for better understanding system differences and identifying areas for further development, such as those studies that compared across countries.

Research methods courses in undergraduate and postgraduate nursing courses commonly emphasise quantitative and qualitative methods. This review identified strong, simple quantitative comparative approaches that were commonly used to draw comparisons, but also that nurse researchers are beginning to adopt more complex comparative analysis approaches. It suggests that comparative approaches are useful and are increasingly being used in nursing to address complex questions. Despite this, comparative analysis research approaches are not readily incorporated into nursing research methodologies courses. The findings of our review suggest that to remain responsive, research methods courses at master's and doctoral levels should incorporate knowledge and skills development in comparative analysis as a viable approach to nursing research, particularly using contemporary approaches such as fuzzy‐set qualitative comparison.

Despite the rich data sourced in the review, there are still some limitations. Firstly, only studies conducted in English were included. Given that we identified comparative analysis being used across different countries, it is possible that relevant studies were not included because of the language in which the reports were written. Only four databases were searched, but these were the most common to contain nursing‐related research, and the search was only using keywords in manuscript titles in order to enable a wide chronological scope to be covered. Hence, we relied on authors to construct meaningful manuscript titles containing their methodology. Therefore, it is possible that other relevant studies were omitted. Despite this, the review adds new knowledge around contemporary research approaches very relevant for nursing research.

5. Conclusion

Comparative analysis is an increasingly applied approach in nursing research and has been widely used to compare different groups, contexts, and practices. While many studies have emerged from the United States, comparative analysis has been increasingly utilised in a vast array of countries, with newer contemporary approaches beginning to emerge. This infers a need for increasing relevant content in nursing research courses to support knowledge and skills development and appreciation of the opportunities it affords.

Author Contributions

Lisa McKenna: conceptualisation, methodology, formal analysis, writing – original draft, writing – review and editing, visualisation. Christine Sommers: conceptualisation, methodology, formal analysis, writing – original draft, writing – review and editing, visualisation.

Conflicts of Interest

The authors declare no conflicts of interest.

McKenna, L. , and Sommers C.. 2025. “Comparative Analysis Methodologies in Nursing Research: A Scoping Review.” Nursing Open 12, no. 9: e70300. 10.1002/nop2.70300.

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.